Chinese Medical Sciences Journal ›› 2022, Vol. 37 ›› Issue (4): 340-348.doi: 10.24920/004085
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Yuxu Zhang1, Rongruo Zeng2, Ye Yang2, Yin Shen1, *()
Received:
2022-03-18
Accepted:
2022-08-02
Published:
2022-12-31
Online:
2022-09-23
Contact:
Yin Shen
E-mail:sy_doctor@163.com
SYNTAX and its derivative scores are a decision-making tool that could quantitatively describe the characteristics of coronary lesions in patients based on their complexity and severity, could assist clinicians in rationalizing the selection of hemodynamic reconstruction treatment strategies, and have demonstrated outstanding value in evaluating the prognosis of patients with complex coronary heart disease undergoing revascularization treatment. The authors summary the practical application of SYNTAX and its derivative scores in complex coronary heart disease in order to deepen the understanding of the relationship between the choice of different revascularization strategies and SYNTAX and its derived scores in complex coronary heart disease and provide a further reference for clinical treatment of complex coronary heart disease. |
Yuxu Zhang, Rongruo Zeng, Ye Yang, Yin Shen. Application of SYNTAX and its Derivative Scores in the Selection of Revascularization Strategies for Complex Coronary Heart Disease[J].Chinese Medical Sciences Journal, 2022, 37(4): 340-348.
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Figure 1.
The evolution of the SYNTAX score and its variants. ACC/AHA: American College of Cardiology/American Heart Association; ACEF: age, creatinine, and ejection fraction score = age (years) /ejection fraction (%) + 1 (if creatinine ≥2 mg/dl); FFR: Fractional Flow Reserve; CrCl: creatinine clearance rate; EF: ejection fraction; BMI: body mass index; LM: left main coronary artery; PVD: peripheral vascular disease; COPD: chronic obstructive pulmonary disease; FFRct: computed tomography-drived FFR."
[1] |
Roth GA, Huffman MD, Moran AE, et al. Global and regional patterns in cardiovascular mortality from 1990 to 2013. Circulation 2015; 132(17):1667-78. doi: 10.1161/circulationaha.114.008720.
doi: 10.1161/CIRCULATIONAHA.114.008720 pmid: 26503749 |
[2] |
Sousa-Uva M, Neumann FJ, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur J Cardiothorac Surg 2019; 55(1):4-90. doi: 10.1093/ejcts/ezy289.
doi: 10.1093/ejcts/ezy289 |
[3] | Hang YL. Guidelines for percutaneous coronary intervention in China (2016). Chin J Cardiol 2016; 44(5):382-400. |
[4] |
Ong AT, Serruys PW, Mohr FW, et al. The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) study: design, rationale, and run-in phase. Am Heart J 2006; 151(6):1194-204. doi: 10.1016/j.ahj.2005.07.017.
doi: 10.1016/j.ahj.2005.07.017 pmid: 16781219 |
[5] |
Serruys PW, Morice MC, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009; 360(10):961-72. doi: 10.1056/NEJMoa0804626.
doi: 10.1056/NEJMoa0804626 |
[6] |
Mohr FW, Morice MC, Kappetein AP, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet 2013; 381(9867):629-38. doi: 10.1016/s0140-6736(13)60141-5.
doi: 10.1016/s0140-6736(13)60141-5 |
[7] |
van Dongen IM, Elias J, García-García HM, et al. Value of the SYNTAX score in ST-elevation myocardial infarction patients with a concomitant chronic total coronary occlusion (from the EXPLORE Trial). Am J Cardiol 2019; 123 (7):1035-43. doi: 10.1016/j.amjcard.2018.12.028.
doi: S0002-9149(19)30031-1 pmid: 30654929 |
[8] |
Shlofmitz E, Généreux P, Chen S, et al. Left main coronary artery disease revascularization according to the SYNTAX score. Circ Cardiovasc Interv 2019; 12(9): e008007. doi: 10.1161/circinterventions.118.008007.
doi: 10.1161/circinterventions.118.008007 |
[9] |
Thuijs D, Kappetein AP, Serruys PW, et al. Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial. Lancet 2019; 394(10206):1325-34. doi: 10.1016/s0140-6736(19)31997-x.
doi: 10.1016/s0140-6736(19)31997-x |
[10] |
Park DW, Kim YH, Yun SC, et al. Complexity of atherosclerotic coronary artery disease and long-term outcomes in patients with unprotected left main disease treated with drug-eluting stents or coronary artery bypass grafting. J Am Coll Cardiol 2011; 57(21):2152-9. doi: 10.1016/j.jacc.2011.01.033.
doi: 10.1016/j.jacc.2011.01.033 |
[11] |
Magro M, Nauta S, Simsek C, et al. Value of the SYNTAX score in patients treated by primary percutaneous coronary intervention for acute ST-elevation myocardial infarction: the MI SYNTAX score study. Am Heart J 2011; 161(4):771-81. doi: 10.1016/j.ahj.2011.01.004.
doi: 10.1016/j.ahj.2011.01.004 |
[12] |
Palmerini T, Genereux P, Caixeta A, et al. Prognostic value of the SYNTAX score in patients with acute coronary syndromes undergoing percutaneous coronary intervention: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. J Am Coll Cardiol 2011; 57(24):2389-97. doi: 10.1016/j.jacc.2011.02.032.
doi: 10.1016/j.jacc.2011.02.032 pmid: 21658558 |
[13] |
Sabatine MS, Bergmark BA, Murphy SA, et al. Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis. Lancet 2021; 398(10318):2247-57. doi: 10.1016/s0140-6736(21)02334-5.
doi: 10.1016/S0140-6736(21)02334-5 pmid: 34793745 |
[14] |
Yoon YH, Ahn JM, Kang DY, et al. Impact of SYNTAX score on 10-year outcomes after revascularization for left main coronary artery disease. JACC Cardiovasc Interv 2020; 13(3):361-71. doi: 10.1016/j.jcin.2019.10.020.
doi: 10.1016/j.jcin.2019.10.020 |
[15] |
Lee J, Ahn JM, Kim JH, et al. Prognostic effect of the SYNTAX score on 10-year outcomes after left main coronary artery revascularization in a randomized population: insights from the extended PRECOMBAT trial. J Am Heart Assoc 2021; 10(14): e020359. doi: 10.1161/jaha. 120.020359.
doi: 10.1161/jaha. 120.020359 |
[16] |
Garg S, Sarno G, Garcia-Garcia HM, et al. A new tool for the risk stratification of patients with complex coronary artery disease: the Clinical SYNTAX Score. Circ Cardiovasc Interv 2010; 3(4):317-26. doi: 10.1161/circinterventions.109.914051.
doi: 10.1161/CIRCINTERVENTIONS.109.914051 pmid: 20647561 |
[17] |
Gao G, Zhang D, Song C, et al. Integrating the residual SYNTAX score to improve the predictive ability of the age, creatinine, and ejection fraction (ACEF) score for cardiac mortality in percutaneous coronary intervention patients. Catheter Cardiovasc Interv 2020; 95 Suppl 1:534-41. doi: 10.1002/ccd.28673.
doi: 10.1002/ccd.28673 |
[18] |
Janella BL, Campos CM, Caixeta A, et al. Assessment of long-term mortality in patients with complex coronary artery disease undergoing percutaneous intervention: comparison of multiple anatomical and clinical prognostic risk scores. EuroIntervention 2017; 13(10):1177-84. doi: 10.4244/eij-d-16-00659.
doi: EIJ-D-16-00659 pmid: 28506936 |
[19] |
Li XQ, Yin C, Li XL, et al. Comparison of the prognostic value of SYNTAX score and clinical SYNTAX score on outcomes of Chinese patients underwent percutaneous coronary intervention. BMC Cardiovasc Disord 2021; 21(1): 334. doi: 10.1186/s12872-021-02144-w.
doi: 10.1186/s12872-021-02144-w |
[20] |
Onuk T, Güngör B, İpek G, et al. Comparison of long-term prognostic value of baseline SYNTAX and clinical SYNTAX scores in ST-segment elevation myocardial infarction patients with multivessel disease. Coron Artery Dis 2016; 27(4):311-8. doi: 10.1097/mca.0000000000000365.
doi: 10.1097/mca.0000000000000365 |
[21] |
Kawashima H, Hara H, Wang R, et al. Usefulness of updated logistic clinical SYNTAX score based on MI-SYNTAX score in patients with ST-elevation myocardial infarction. Catheter Cardiovasc Interv 2021; 97(7): E919-e28. doi: 10.1002/ccd.29383.
doi: 10.1002/ccd.29383 |
[22] |
Song Y, Gao Z, Tang XF, et al. Impact of residual SYNTAX score and its derived indexes on clinical outcomes after percutaneous coronary intervention: data from a large single center. Chin Med J (Engl) 2018; 131(12):1390-6. doi: 10.4103/0366-6999.233958.
doi: 10.4103/0366-6999.233958 |
[23] |
Collet C, Onuma Y, Miyazaki Y, et al. Integration of non-invasive functional assessments with anatomical risk stratification in complex coronary artery disease: the non-invasive functional SYNTAX score. Cardiovasc Diagn Ther 2017; 7(2):151-8. doi: 10.21037/cdt.2017.03.19.
doi: 10.21037/cdt.2017.03.19 |
[24] |
Kundu A, Sardar P, O’Day K, et al. SYNTAX score and outcomes of coronary revascularization in diabetic patients. Curr Cardiol Rep 2018; 20(5): 28. doi: 10.1007/s11886-018-0971-1.
doi: 10.1007/s11886-018-0971-1 pmid: 29572680 |
[25] |
He J, Zhao H, Yu X, et al. SYNTAX score-Ⅱ predicts long-term mortality in patients who underwent left main percutaneous coronary intervention treated with second-generation drug-eluting stents. Int Heart J 2017; 58(3):344-50. doi: 10.1536/ihj.16-292.
doi: 10.1536/ihj.16-292 |
[26] |
Xu B, Généreux P, Yang Y, et al. Validation and comparison of the long-term prognostic capability of the SYNTAX score-Ⅱ among 1,528 consecutive patients who underwent left main percutaneous coronary intervention. JACC Cardiovasc Interv 2014; 7 (10):1128-37. doi: 10.1016/j.jcin.2014.05.018.
doi: 10.1016/j.jcin.2014.05.018 |
[27] |
Salvatore A, Boukhris M, Giubilato S, et al. Usefulness of SYNTAX score Ⅱ in complex percutaneous coronary interventions in the setting of acute coronary syndrome. J Saudi Heart Assoc 2016; 28(2):63-72. doi: 10.1016/j.jsha.2015.07.003.
doi: 10.1016/j.jsha.2015.07.003 |
[28] |
Campos CM, van Klaveren D, Farooq V, et al. Long-term forecasting and comparison of mortality in the evaluation of the Xience Everolimus eluting stent vs. coronary artery bypass surgery for effectiveness of left main revascularization (EXCEL) trial: prospective validation of the SYNTAX score Ⅱ. Eur Heart J 2015; 36(20):1231-41. doi: 10.1093/eurheartj/ehu518.
doi: 10.1093/eurheartj/ehu518 |
[29] |
Hara H, Shiomi H, van Klaveren D, et al. External validation of the SYNTAX score Ⅱ 2020. J Am Coll Cardiol 2021; 78 (12):1227-38. doi: 10.1016/j.jacc.2021.07.027.
doi: 10.1016/j.jacc.2021.07.027 |
[30] |
He JQ, Yu XP, Peng C, et al. Predictive ability of the SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery score Ⅱ for long-term mortality in patients with three-vessel coronary artery disease undergoing percutaneous coronary intervention treated with second-generation drug-eluting stents. Chin Med J (Engl) 2015; 128(16):2176-82. doi: 10.4103/0366-6999.162510.
doi: 10.4103/0366-6999.162510 |
[31] |
Takahashi K, Serruys PW, Fuster V, et al. Redevelopment and validation of the SYNTAX score Ⅱ to individualise decision making between percutaneous and surgical revascularisation in patients with complex coronary artery disease: secondary analysis of the multicentre randomised controlled SYNTAXES trial with external cohort validation. Lancet 2020; 396(10260):1399-412. doi: 10.1016/s0140-6736(20)32114-0.
doi: 10.1016/S0140-6736(20)32114-0 pmid: 33038944 |
[32] |
Yang H, Zhang Land Xu CH. Use of the SYNTAX score Ⅱ to predict mortality in interventional cardiology: a systematic review and meta-analysis. Medicine (Baltimore) 2019; 98(2): e14043. doi: 10.1097/md.0000000000014043.
doi: 10.1097/md.0000000000014043 |
[33] |
Yesin M, Çağdaş M, Kalçık M, et al. Comparison of syntax score and syntax score Ⅱ to predict “no reflow phenomenon” in patients with ST-segment elevation myocardial infarction. Int J Cardiovasc Imaging 2017; 33 (12):1883-9. doi: 10.1007/s10554-017-1200-5.
doi: 10.1007/s10554-017-1200-5 |
[34] |
Campos CM, van Klaveren D, Iqbal J, et al. Predictive performance of SYNTAX score Ⅱ in patients with left main and multivessel coronary artery disease-analysis of CREDO-Kyoto registry. Circ J 2014; 78(8):1942-9. doi: 10.1253/circj.cj-14-0204.
doi: 10.1253/circj.cj-14-0204 |
[35] | Chen H, Li JX, Wang H, et al. Correlation between SYNTAX score of coronary heart disease and ultrasound-guided cerebral infarction typing in patients with coronary artery diseases. Chin Circ J 2021; 36(2):144-8. |
[36] |
Obeid S, Attinger-Toller A, Taramasso M, et al. SYNTAX score Ⅱ in patients with coronary artery disease undergoing percutaneous mitral repair with the MitraClip. Int J Cardiol 2017; 236:375-80. doi: 10.1016/j.ijcard.2017.02.049.
doi: 10.1016/j.ijcard.2017.02.049 |
[37] |
Bangalore S, Toklu B, Wetterslev J. Complete versus culprit-only revascularization for ST-segment-elevation myocardial infarction and multivessel disease: a meta-analysis and trial sequential analysis of randomized trials. Circ Cardiovasc Interv 2015; 8(4): 10. doi: 10.1161/circinterventions.114.002142.
doi: 10.1161/circinterventions.114.002142 |
[38] |
Lee JM, Rhee TM, Hahn JY, et al. Multivessel percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction with cardiogenic shock. J Am Coll Cardiol 2018; 71(8):844-56. doi: 10.1016/j.jacc.2017.12.028.
doi: S0735-1097(17)42016-X pmid: 29471935 |
[39] |
٣٩. Wang Y, Zhao X, Zhou P, et al. Culprit-plaque morphology and residual SYNTAX score predict cardiovascular risk in acute myocardial infarction: an optical coherence tomography study. J Atheroscler Thromb 2021; 29(9):1328-41. doi: 10.5551/jat.63103.
doi: 10.5551/jat.63103 pmid: 34544957 |
[40] |
Alidoosti M, Saroukhani S, Lotfi-Tokaldany M, et al. Objectifying the level of incomplete revascularization by the residual SYNTAX score and evaluating its impact on the one-year outcome of percutaneous coronary intervention in patients with multi-vessel disease. Cardiovasc Revasc Med 2016; 17(5):308-12. doi: 10.1016/j.carrev.2016.03.009.
doi: 10.1016/j.carrev.2016.03.009 |
[41] |
Généreux P, Palmerini T, Caixeta A, et al. Quantification and impact of untreated coronary artery disease after percutaneous coronary intervention: the residual SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score. J Am Coll Cardiol 2012; 59 (24):2165-74. doi: 10.1016/j.jacc.2012.03.010.
doi: 10.1016/j.jacc.2012.03.010 pmid: 22483327 |
[42] |
Kochar A, Varshney AS, Wang DE. Residual SYNTAX score after revascularization in cardiogenic shock: when is complete complete? J Am Coll Cardiol 2021; 77(2):156-8. doi: 10.1016/j.jacc.2020.11.034.
doi: 10.1016/j.jacc.2020.11.034 pmid: 33446308 |
[43] |
Takahashi K, Serruys PW, Gao C, et al. Ten-year all-cause death according to completeness of revascularization in patients with three-vessel disease or left main coronary artery disease: insights from the SYNTAX extended survival study. Circulation 2021; 144(2):96-109. doi: 10.1161/circulationaha.120.046289.
doi: 10.1161/CIRCULATIONAHA.120.046289 pmid: 34011163 |
[44] |
Lee SH, Choi KH, Lee JM, et al. Residual functional SYNTAX score by quantitative flow ratio and improvement of exercise capacity after revascularization. Catheter Cardiovasc Interv 2021; 97(4): E454-e66. doi: 10.1002/ccd.29118.
doi: 10.1002/ccd.29118 |
[45] |
Nam CW, Mangiacapra F, Entjes R, et al. Functional SYNTAX score for risk assessment in multivessel coronary artery disease. J Am Coll Cardiol 2011; 58(12):1211-8. doi: 10.1016/j.jacc.2011.06.020.
doi: 10.1016/j.jacc.2011.06.020 |
[46] |
Gong Y, Zheng B, Yi T, et al. Coronary angiography-derived contrast fractional flow reserve. Catheter Cardiovasc Interv 2022; 99(3):763-71. doi: 10.1002/ccd.29558.
doi: 10.1002/ccd.29558 |
[47] |
Li J, Gong Y, Wang W, et al. Accuracy of computational pressure-fluid dynamics applied to coronary angiography to derive fractional flow reserve: FLASH FFR. Cardiovasc Res 2020; 116(7):1349-56. doi: 10.1093/cvr/cvz289.
doi: 10.1093/cvr/cvz289 pmid: 31693092 |
[48] |
Pan J, Zhang Q, Lei L, et al. Impact of the caFFR-guided functional SYNTAX score on ventricular tachycardia/fibrillation development in patients with acute myocardial infarction. Front Cardiovasc Med 2022; 9:807805. doi: 10.3389/fcvm.2022.807805.
doi: 10.3389/fcvm.2022.807805 |
[49] |
Asano T, Katagiri Y, Chang CC, et al. Angiography-derived fractional flow reserve in the SYNTAXⅡ trial: feasibility, diagnostic performance of quantitative flow ratio, and clinical prognostic value of functional SYNTAX score derived from quantitative flow ratio in patients with 3-vessel disease. JACC Cardiovasc Interv 2019;12(3):259-70. doi: 10.1016/j.jcin.2018.09.023.
doi: 10.1016/j.jcin.2018.09.023 |
[50] |
Zhang R, Song C, Guan C, et al. Prognostic value of quantitative flow ratio based functional SYNTAX score in patients with left main or multivessel coronary artery disease. Circ Cardiovasc Interv 2020; 13(10): e009155. doi: 10.1161/circinterventions.120.009155.
doi: 10.1161/circinterventions.120.009155 |
[51] |
Sonck J, Miyazaki Y, Collet C, et al. Feasibility of planning coronary artery bypass grafting based only on coronary computed tomography angiography and CT-derived fractional flow reserve: a pilot survey of the surgeons involved in the randomized SYNTAX Ⅲ revolution trial. Interact Cardiovasc Thorac Surg 2019; 29(2):209-16. doi: 10.1093/icvts/ivz046.
doi: 10.1093/icvts/ivz046 |
[52] |
Kerner A, Abadi S, Abergel E, et al. Direct comparison between coronary computed tomography and invasive angiography for calculation of SYNTAX score. EuroIntervention 2013; 8(12):1428-34. doi: 10.4244/eijv8i12a216.
doi: 10.4244/EIJV8I12A216 pmid: 23680958 |
[53] |
Collet C, Onuma Y, Andreini D, et al. Coronary computed tomography angiography for heart team decision-making in multivessel coronary artery disease. Eur Heart J 2018; 39(41):3689-98. doi: 10.1093/eurheartj/ehy581.
doi: 10.1093/eurheartj/ehy581 pmid: 30312411 |
[54] |
Modolo R, Collet C, Onuma Y, et al. SYNTAX Ⅱ and SYNTAX Ⅲ trials: what is the take home message for surgeons? Ann Cardiothorac Surg 2018;7(4):470-82. doi: 10.21037/acs.2018.07.02.
doi: 10.21037/acs.2018.07.02 |
[55] |
Katagiri Y, Andreini D, Miyazaki Y, et al. Site vs. core laboratory variability in computed tomographic angiography-derived SYNTAX scores in the SYNTAX Ⅲ trial. Eur Heart J Cardiovasc Imaging 2021; 22(9):1063-71. doi: 10.1093/ehjci/jeaa172.
doi: 10.1093/ehjci/jeaa172 |
[56] |
Nørgaard BL, Gaur S, Leipsic J, et al. Influence of coronary calcification on the diagnostic performance of CT angiography derived FFR in coronary artery disease: a substudy of the NXT trial. JACC Cardiovasc Imaging 2015; 8(9):1045-55. doi: 10.1016/j.jcmg.2015.06.003.
doi: S1936-878X(15)00420-9 pmid: 26298072 |
[57] |
Nørgaard BL, Leipsic J, Achenbach S. Coronary CT angiography to guide treatment decision making: lessons from the SYNTAX Ⅱ trial. J Am Coll Cardiol 2018; 71(24):2770-2. doi: 10.1016/j.jacc.2018.02.052.
doi: S0735-1097(18)33491-0 pmid: 29802015 |
[58] |
Collet C, Miyazaki Y, Ryan N, et al. Fractional flow reserve derived from computed tomographic angiography in patients with multivessel CAD. J Am Coll Cardiol 2018; 71(24):2756-69. doi: 10.1016/j.jacc.2018.02.053.
doi: S0735-1097(18)33492-2 pmid: 29802016 |
[59] |
Qiao HY, Li JH, Schoepf UJ, et al. Prognostic implication of CT-FFR based functional SYNTAX score in patients with de novo three-vessel disease. Eur Heart J Cardiovasc Imaging 2020; 22(12):1434-42. doi: 10.1093/ehjci/jeaa256.
doi: 10.1093/ehjci/jeaa256 |
[60] |
Nørgaard BL, Leipsic J, Gaur S, et al. Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). J Am Coll Cardiol 2014; 63(12):1145-55. doi: 10.1016/j.jacc.2013.11.043.
doi: S0735-1097(14)00165-X pmid: 24486266 |
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