Global Risk Classification and Clinical SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) Score in Patients Undergoing Percutaneous or Surgical Left Main Revascularization

Abstract

In LM patients undergoing PCI, combined scores improve the discrimination accuracy of clinical or angiographic stand-alone tools. In LM patients undergoing CABG, the ACEF score has the best prognostic accuracy compared with other stand-alone or combined scores. The good predictive ability for PCI along with the poor predictive ability for CABG make the SYNTAX score the preferable decision-making tool in LM disease.

Clinical Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Surgery in High Surgical Risk Patients With Left Main or Three-Vessel Coronary Artery Disease

“…35 Newer scoring methods for PCI that add clinical variables to angiographic characteristics, like the "clinical SYNTAX score" and the "SYNTAX II score," have shown better accuracy than the angiographic SYNTAX score used in this study in predicting adverse events. 36,37 Unfortunately, unlike the angiographic SYNTAX score, these newer scores have not been tested in a study on CABG patients and have not made it into routine clinical practice. In our study it was not entirely clear for all patients how decisions were made to undergo one method of revascularization versus the other.…”

A Tale of Two Techniques: Demystifying the Myth

“…The anatomical SYNTAX score, with low (<23), intermediate (23)(24)(25)(26)(27)(28)(29)(30)(31)(32) or high (>32) categories, 8,12 became a sentinel tool in the SYNTAX trial and pioneered the now-popular "Heart Team" approach, in which a cardiac surgeon and interventional cardiologist determine the optimal revascularization modality for patients with 3VD/ULMCA disease. It combines the importance of diseased vessel segment weighting (Leaman score), adverse lesion characteristics (American College of Cardiology/American Heart Association lesion classification, and total occlusion characteristics from the European TOTAL Surveillance Study) and the Medina classification system for bifurcation lesions.…”

“…age/ejection fraction + 1 point for every 10 ml/ min reduction in creatinine clearance below 60 ml/ min/1.73 m 2 (up to a maximum of 6 points)]), the Global Risk score (a combination of the SYNTAX score and EuroSCORE) and the EuroHeart score. [18][19][20][21][22][23][24][25][26][27] The latest addition to this risk stratification mélange is the SYNTAX score II, which includes a nomogram for bedside application to obtain long-term mortality predictions for individual patients considering CABG or PCI. 28 This score, which was externally validated in the multinational DELTA (n=2,891) and Credo-KYOTO (n=3,896) registries, 8,29 consists of two anatomical (SYNTAX score and ULMCA disease) and six clinical (age, creatinine clearance, left ventricular ejection fraction, sex, chronic obstructive pulmonary disease and peripheral vascular disease) variables.…”

Almanac 2012: cardiovascular risk scores. The journals present selected research that has driven recent advances in clinical cardiology

“…More recently, a number of risk scores has been developed that combine clinical and anatomical information (36)(37)(38)(39)(40)(41)(42). The Euro-Heart score is constructed from 12 clinical characteristics and four lesion characteristics.…”