Modifying angiographic syntax score according to PCI strategy: lessons learnt from ERACI IV Study

Abstract

In recent years an angiographic score was introduced in clinical practice to stratified different levels of risk after percutaneous coronary interventions (PCI) with drug eluting stents. The SYNTAX score (SS) classified patients in three different risk levels and was included in revascularization guidelines that patients allocated with low SS could be equally treated with either PCI or CABG, whereas those with intermediate or high SS were better off with CABG. However, using original SS each coronary lesion with a diameter stenosis ≥50% in vessels ≥1.5 mm was scored. In ERACI IV registry we used a revascularization strategy during PCI where operators were advised to only treat lesions≥than 70% in a≥2.0 mm reference vessel; therefore, no intermediate lesions should be treated, and severe stenosis in vessels<2.0 mm was discouraged as well. If we recalculated SS using the above-mentioned operators' advices all intermediate lesions were not scored, and severe stenosis in vessels<2.0 mm were excluded for the analysis, including bifurcations, trifurcations and chronic total occlusions; after this new scoring, the original SS dropped significantly which is in accordance with the goal of complete functional revascularization strategy of the ERACI IV study and the low one year adverse events of such study. In conclusion, if we performed an SS scoring, only severe stenosis in vessels with a reference diameter ≥2.0 mm would allow a more rational assessment of coronary anatomy, and the use of a more conservative PCI strategy.

Second vs. First generation drug eluting stents in multiple vessel disease and left main stenosis: Two‐year follow‐up of the observational, prospective, controlled, and multicenter ERACI IV registry

“…In‐stent restenosis was scored as heavy calcified stenosis. This new scoring was in agreement with the PCI strategy used in the study and was reported in detail elsewhere .…”

In Hospital and 30 Days Results of the Prospective, Observational, Multicenter and Controlled “real world” WALTZ Registry

“…In WALTZ registry, original Syntax Score (SS) was calculated, however, we also used a modification of the original SS, ERACI score, excluding from the analysis all intermediate lesions and severe stenosis in vessels <2.0 mm. This new scoring was in agreement with the PCI strategy used in the study and was reported in detail elsewhere [15][16] . Furthermore, as part of secondary endpoints in a "post hoc analysis", SS and ERACI risk scores at baseline and after stent deployment were both measured and correlated with late outcome.…”

“…The strategy of staged procedures was not allowed either in target or non-target vessel. According to our previous PCI and stent deployment strategy, mild or intermediate stenosis (50-<70%) was not treated and stent was indicated (by visual estimation) in severe stenosis only; provisional stent strategy was recommended in all bifurcations while strongly discouraged for, severe stenosis in vessels <2.0 mm at it was not to be part of the revascularization strategy 16 .…”

The value of the Clinical SYNTAX Score in predicting long-term prognosis in patients with ST-segment elevation myocardial infarction who have undergone primary percutaneous coronary intervention

“…Furthermore, the major limitation of the original Sx score was also present in the CSS, that is, to score intermediate lesion (50 to <70%) as well severe stenosis in vessels less than 2.0 mm. Recently, a new study constructed a modified Sx score and they excluded all severe stenosis in vessels less than 2.0 mm and all intermediate lesions, and this policy enables them to use a more conservative strategy during DES implantation [20]. Although the follow-up period was 15 months, a longer follow-up might show some differences in the results.…”