Integration of non-invasive functional assessments with anatomical risk stratification in complex coronary artery disease: the non-invasive functional SYNTAX score

Abstract

Since the early days of coronary angiography, the extension and severity of coronary artery disease (CAD) have been used for risk stratification. The SYNTAX score objectively characterizes CAD in patients with multivessel disease. Furthermore, recalculating the SYNTAX score by the incorporation of the functional component coronary stenosis (i.e., FFR) increases the discrimination for the risk of adverse events. The calculation of the SYNTAX score derived from non-invasive modalities such as coronary computed tomography angiography (CTA) has emerged as a mean to obtain the SYNTAX score before invasive cardiac catheterization. Likewise, the computation of the non-invasive fractional flow reserve CT (FFR) allows for the calculation of the non-invasive functional SYNTAX score. Ultimately, the combination of anatomical and functional evaluations with clinical factors further refines the identification of patients at risk and provides a recommendation for the Heart Team regarding the treatment strategy (i.e., PCI or CABG) based on the predicted 4-year mortality. The purpose of this review is to describe the integration of a novel non-invasive functional coronary assessment with the angiographic risk score in patients with multivessel CAD.

Planning percutaneous coronary interventions using computed tomography angiography and fractional flow reserve‐derived from computed tomography: A state‐of‐the‐art review

“…While not yet incorporated into worldwide societal guidelines, a natural evolution of our understanding of CTA and FFRCT is to apply these noninvasive tools to decision‐making in high‐risk patients with multivessel and/or left main CAD , potentially without invasive angiography. As is true with invasive angiography and FFRINV, risk scores incorporating anatomic and physiologic variables can be created using CTA and FFRCT (anatomic and functional SYNTAX scores) . In fact, a recent editorial suggested that the era of performing ICA for patients with symptoms and an abnormal stress test may be coming to an end; we may be on the verge of a significant paradigm shift in which CAD is characterized noninvasively by CTA and FFRct .…”

Hybrid anatomo-functional imaging of coronary artery disease: Beneficial irrespective of its core components

“…26,55 This was most recently extended to noninvasive assessment of CAD with CT-FFR. 56 Accordingly, we hereby propose in general terms for the first time that anatomic and functional SYNTAX scores can be computed non-invasively with the combination of CTA and any non-invasive functional test (Figure 4). The importance of jointly appraising anatomic and functional significance of a coronary lesion is all too evident when, for instance, comparing the clinical impact of a proximal LAD lesion with complex angiographic features and causing extensive and severe myocardial ischemia versus that of a distal lesion of a Figure 4.…”

The father of coronary artery bypass grafting: René Favaloro and the 50th anniversary of coronary artery bypass grafting

“…40 Today, additional physiologic and imaging modalities are further refining the prognostic importance of coronary lesions and patient selection for intervention. 41 In one of his last comprehensive reviews of CABG in 1998, 39 Favaloro skillfully summarized the CABG evolution from the refinements of instruments and sutures to improvements in perfusion, myocardial protection, and perioperative care. He touched on important developments, including arterial conduits, off-pump surgery, minimally invasive surgery, and risk-adjusted outcomes, that importantly relate to current-day practice.…”