P4593Effectiveness of using the Syntax Score II calculator for the patients with multi-vessel coronary arteries lesion

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
B Alekyan ◽  
N Karapetyan ◽  
D Kishmiryan
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Fatal Outcome ◽  
Myocardial Revascularization ◽  
Complete Agreement ◽  
Syntax Score ◽  
Heart Team ◽  
Clinical Indicators ◽  
Syntax Score Ii ◽  
Team Decision

Abstract Introduction The most significant disadvantage of the SYNTAX score is the lack of an individualized approach due to the absence of the clinical parameters. The Syntax Score II calculator which includes 6 clinical indicators is more accurate decision-making tool that should help the “heart team” to choose a strategy for myocardial revascularization. The purpose of the study was to examine the effectiveness of using Syntax Score II for patients with multi-vessel coronary artery lesions who was dedicated to PCI. Material and methods From 01/2018 to 12/2018, 760 patients were included in the research, who was dedicated to PCI by the decision of the local “heart team”. In present analysis were included 116 (15%) of these patients with the multi-vessel coronary lesion and with a left main coronary artery lesion of different complexity. Patients who had previously undergone myocardial revascularization were excluded from analysis. The age of patients ranged from 41 to 86 years (mean age 67 + 9 years). There were males - 67.2%. Diabetes mellitus was present in 34.5% of the patients. 42.2% of the patients had angina pectoris (NYHA 3–4), and 60.3% had II class chronic heart failure. Results The average Syntax Score of the 116 patients was 23.1 + 7.8 (from 11 to 59). Syntax Score of the 52 (44.8%) patients was more than 23, and less than 23 in 64 (55.2%) of the cases. The Syntax Score II for the same patients recommended only CABG in 13 (11.2%), only PCI - in 6 (5.2%) and equality between methods - in 97 (83.6%) cases. Only in 6 (5.2%) patients, there was complete agreement between the risk scales, and for 53 (45.7%) of them, the methods were equal. For 44 (37.9%) patients, the Syntax score recommended CABG (Syntax score more than 23), and Syntax Score II indicated equality of methods. In 2 (1.7%) patients with a SYNTAX score of more than 23 the Syntax Score II nevertheless recommended PCI. The “heart team” decision and the Syntax Score II recommendation were in agreement in 103 (88.8%) of the cases, while the “heart team” decision and the SYNTAX recommendation were in agreement only in 64 (55.2%) of the cases. At the hospital stage, there were 2 (1.7%) cases of stent thrombosis with a fatal outcome, both in patients with SYNTAX score 42 and 28. To determine the degree of consistency between the risk scales, the Kappa Cohen coefficient was calculated, which was 0.06 (p=0.93), which indicates lack of consistency between SYNTAX and Syntax Score II in recommendations. Conclusion The Syntax Score II risk scale is an effective tool for making “heart team” decisions about myocardial revascularization method and expands indications for performing PCI, and in 88.8% of cases with multi-vessel coronary arteries lesion, it is possible to get equal predictions between the methods of revascularization. In 40% of cases in patients with a SYNTAX of more than 23 Syntax Score II determines an equiprobable prognosis for performing PCI and CABG.

scholarly journals Роль шкалы SYNTAX Score II в принятия решений «сердечной командой» о методе лечения пациентов со сложными поражениями коронарных артерий. Обзор литературы

2019 ◽  
pp. 17-25
Author(s):  
B.G. ALEKYAN ◽  
N.G. KARAPETYAN ◽  
V.V. KRAVCHENKO ◽  
A.SH. REVISHVILI
Keyword(s):  
Cardiac Surgery ◽  
Clinical Practice ◽  
Myocardial Revascularization ◽  
Syntax Score ◽  
Heart Team ◽  
Syntax Score Ii ◽  
Percutaneous Coronary ◽  
European Society Of Cardiology ◽  
Syntax Study ◽  
Risk Scale

С момента своего внедрения в клиническую практику чрескожные коронарные вмешательства (ЧКВ) постепенно стали методом выбора при лечении пациентов с локальными и несложными поражениями венечных артерий, резистентных к оптимальной медикаментозной терапии. Несмотря на это, использование ЧКВ для лечения пациентов с тяжелыми формами поражений коронарных артерий является предметом разночтений и споров и в настоящее время. В эпоху стентов с лекарственным антипролиферативным покрытием одним из наиболее важных и значимых исследований эффективности ЧКВ и коронарного шунтирования является, бесспорно, исследование SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery согласованность ЧКВ с имплантацией стентов TAXUS и кардиохирургией). Полученные в ходе данного исследования результаты легли в основу рекомендаций по реваску1 ляризации миокарда Европейского общества кардиологов (ЕОК) 2014 и 2018 гг. Однако на данный момент имеются крайне важные и принципиальные несоответствия между современной клинической практикой и рандомизированным исследованием SYNTAX. Наибо1 лее существенным недостатком шкалы риска SYNTAX считается отсутствие индивидуализированного подхода при принятии решения о выборе метода реваскуляризации миокарда в силу отсутствия в ней клинических переменных. В данной статье будет рассмотрена новая шкала риска SYNTAX Score II (SS II) как более точный инструмент принятия решения в работе сердечной команды .Since its introduction into clinical practice, percutaneous coronary interventions (PCI) have gradually become the method of choice for treating patients with local and uncomplicated lesions of the coronary arteries that are resistant to optimal medicamental therapy. Despite this, the use of PCI for the treatment of patients with coronary artery disease carts is a matter of discrepancies and disputes even today. In the era of drug1elongated antiproliferative stents, one of the most important and significant studies of the efficacy of PCI and coronary shunting (CS) is undoubtedly the SYNTAX study (Synergy between TAXUS and Cardiac Surgery implantation of TAXUS and Cardiac Surgery). The results of this study formed the basis for the latest recommendations on myocardial revascularization of the European Society of Cardiology (EOC) 2014 and beyond 2018. However, at the moment there are extremely important and fundamental inconsistencies between modern clinical practice and the randomized SYNTAX study. The most significant drawback of the SYNTAX risk scale is the lack of an individualized approach when deciding on the choice of myocardial revascularization method due to the absence of clinical variables in it. This article will look at the new Syntax Score II risk scale as a more accurate decision1making tool in the work of the heart team.Since its introduction into clinical practice, percutaneous coronary interventions (PCI) have gradually become the method of choice for treating patients with local and uncomplicated lesions of the coronary arteries that are resistant to optimal medicamental therapy. Despite this, the use of PCI for the treatment of patients with coronary artery disease carts is a matter of discrepancies and disputes even today. In the era of drug1elongated antiproliferative stents, one of the most important and significant studies of the efficacy of PCI and coronary shunting (CS) is undoubtedly the SYNTAX study (Synergy between TAXUS and Cardiac Surgery implantation of TAXUS and Cardiac Surgery). The results of this study formed the basis for the latest recommendations on myocardial revascularization of the European Society of Cardiology (EOC) 2014 and beyond 2018. However, at the moment there are extremely important and fundamental inconsistencies between modern clinical practice and the randomized SYNTAX study. The most significant drawback of the SYNTAX risk scale is the lack of an individualized approach when deciding on the choice of myocardial revascularization method due to the absence of clinical variables in it. This article will look at the new Syntax Score II risk scale as a more accurate decision1making tool in the work of the heart team.

scholarly journals A multidisciplinary approach in determining of prevalence of coronary artery disease and treatment strategies in patients with pathology of the aorta and peripheral arteries

2019 ◽  
pp. 8-16
Author(s):  
B. G. Alekyan ◽  
A. V. Pokrovsky ◽  
N. G. Karapetyan ◽  
А. Sh. Revishvili
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Treatment Strategy ◽  
Multidisciplinary Approach ◽  
Fatal Outcome ◽  
Myocardial Revascularization ◽  
Heart Team ◽  
Peripheral Arteries ◽  
Femoral Arteries ◽  
Artery Disease

The treatment of coronary artery disease (CAD) in patients with combined pathology of peripheral arteries who are to perform endovascular or surgical interventions is a difficult task. The most important issues are the adequate diagnostics of artery systems’ lesions, determining the most optimal strategy and stages of treatment. This makes a multidisciplinary approach with the involvement of various specialists the most optimal.Aim. Based on multidisciplinary approach, to determine the prevalence of CAD and treatment strategy in patients with lesions of the aorta and peripheral arteries.8Material and methods. The study included 693 patients with pathology of the aorta and peripheral arteries: 171 (32,5%) were female, and 522 (75,3%) were male. The age of patients ranged from 29 to 93 years, an average — 67,2+8,8 years. Also 32,5% of patients (n=223) were older than 71 years. Cardiac complaints were present only in 203 (29,3%) patients, while 490 (70,7%) were asymptomatic. The majority of 693 patients had an isolated lesion of the internal carotid artery (ICA) (n=196, 28,3%), a combined lesion of the ICA and lower limb arteries (n=93, 13,4%), a combined lesion of the iliac and superficial femoral arteries (n=70, 10,1%) and femoral arteries lesions (n=60, 8,6%).Results. Finally, 554 (79,9%) of 693 patients had lesions of at least one coronary artery more than 50%, while 368 (66,4%) of them were clinically asymptomatic. By the decision of the multidisciplinary heart team, 316 (57,0%) patients underwent myocardial revascularization operations: 21 (6,7%) — coronary artery bypass grafting and 295 (50,3%) — percutaneous coronary intervention. Surgical and endovascular operations for pathology of the aorta and peripheral arteries were performed in 486 (70,1%) of 693 patients. Unlike with 260 (53,5%) patients, in 226 (46,5%) patients, in addition to vascular surgery, myocardial revascularization was performed. As a result of 923 (564 endovascular and 359 surgical) operations performed in 580 patients at the hospital stage, 3 (0,51%) of them had a fatal outcome. In other 2 (0,56%) cases, there was stroke: in one case after ICA prosthetics, in the other case — thrombosis of the ICA after the carotid endarterectomy. Acute myocardial infarction at the hospital stage was not detected in any of the patients.Conclusion. In 79,9% of patients with atherosclerosis of the aorta and peripheral arteries, at least one coronary artery lesion of more than 50% is detected. In 66,4% of patients with pathology of the aorta and peripheral arteries and with lesions of the coronary arteries of more than 50%, there are no cardiac complaints. In 45,6% of patients hospitalized with a diagnosis of atherosclerotic lesions of the aorta and peripheral arteries, myocardial revascularization is required. A multidisciplinary approach is an effective and safe treatment strategy for patients with pathology of the aorta and peripheral arteries of atherosclerotic origin and concomitant CAD.

scholarly journals Association of GRACE Risk Score with Coronary Artery Disease Complexity in Patients with Acute Coronary Syndrome

2021 ◽  
Vol 10 (10) ◽  
pp. 2210
Author(s):  
Georgios Sofidis ◽  
Nikolaos Otountzidis ◽  
Nikolaos Stalikas ◽  
Efstratios Karagiannidis ◽  
Andreas S. Papazoglou ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Syntax Score ◽  
Heart Team ◽  
Characteristic Analysis ◽  
Positive Correlation ◽  
Coronary Syndrome ◽  
Artery Disease ◽  
Grace Score

The GRACE score constitutes a useful tool for risk stratification in patients with acute coronary syndrome (ACS), while the SYNTAX score determines the complexity of coronary artery disease (CAD). This study sought to correlate these scores and assess the accuracy of the GRACE score in predicting the extent of CAD. A total of 539 patients with ACS undergoing coronary angiography were included in this analysis. The patients were classified into those with a SYNTAX score < 33 and a SYNTAX score ≥ 33. Spearman’s correlation and receiver operator characteristic analysis were conducted to investigate the role of the GRACE score as a predictor of the SYNTAX score. There was a significantly positive correlation between the SYNTAX and the GRACE scores (r = 0.32, p < 0.001). The GRACE score predicted severe CAD (SYNTAX ≥ 33) moderately well (the area under the curve was 0.595 (0.522–0.667)). A GRACE score of 126 was documented as the optimal cut-off for the prediction of a SYNTAX score ≥ 33 (sensitivity = 53.5% and specificity = 66%). Therefore, our study reports a significantly positive correlation between the GRACE and the SYNTAX score in patients with ACS. Notably, NSTEMI patients with a high-risk coronary anatomy have higher calculated GRACE scores. A multidisciplinary approach by a heart team could possibly alter the therapeutic approach and management in patients presenting with ACS and a high calculated GRACE score.

SYNTAX score and coronary artery bypass graft surgery in Bangladesh

2019 ◽  
Vol 27 (7) ◽  
pp. 542-547
Author(s):  
Redoy Ranjan ◽  
Asit Baran Adhikary
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Myocardial Revascularization ◽  
Syntax Score ◽  
Artery Bypass Graft ◽  
Artery Disease

Background The SYNTAX score is a helpful tool for determining the optimal myocardial revascularization strategy in complex coronary artery disease. The aim of this study was to assess whether the SYNTAX score predicts postoperative mortality in patients undergoing coronary artery bypass grafting. Methods The study included 1100 consecutive patients referred for coronary artery bypass graft surgery over a 4-year period. Angiographic data were interpreted by both experienced intervention cardiologists and cardiac surgeons. The patients were divided into three groups based on SYNTAX score tertiles: low ≤22 ( n =  560), intermediate 23–32 ( n =  360), and high ≥33 ( n =  180). Results Compared to patients with a low SYNTAX score, those with intermediate and high scores were significantly older ( p <  0.001), had a lower left ventricular ejection fraction ( p <  0.001), higher pulmonary artery pressure ( p <  0.001), and higher incidences of acute coronary syndrome and left main coronary artery disease. A significantly higher EuroSCORE ( p =  0.003) was also observed in patients with a higher SYNTAX score. Patients with intermediate and high SYNTAX scores had higher 5-year mortality rates (18.6% and 19.5%, respectively) than patients with low SYNTAX scores (9.5%, p <  0.05). In multivariate analysis, SYNTAX score was not an independent predictor of late mortality. Conclusion Although SYNTAX score is not independently predictive of late mortality in patients with complex coronary artery disease undergoing myocardial revascularization surgery, patients with lower SYNTAX scores had a lower mortality rate after coronary artery bypass graft surgery.

scholarly journals Angiographic profile of coronary arteries in Keralite population

2014 ◽  
Vol 03 (03) ◽  
pp. 143-149
Author(s):  
Apsara M P.
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Right Coronary Artery ◽  
Research Work ◽  
Myocardial Revascularization ◽  
Chi Square ◽  
Circumflex Artery ◽  
Chi Square Test ◽  
The Right ◽  
Coronary Angiograms

Abstract Background and aims: The incidence of Coronary Artery Disease (CAD) has reached alanning proportions in India. The pathological hall mark of CAD is myocardial ischemia resulting from the atherosclerotic narrowing of coronary arteries. In this era of advanced interventions and cardiac surgery, a thorough knowledge of normal and variant anatomy of coronary arteries is of prime significance and of great use both to the clinicians and anatomists. Materials and methods: One hundred coronary angiograms of patients free of disease were studied in detail in different profiles. The data obtained was quantified according to their frequencies. The relation between the length of left main coronary artery and coronary artery dominance was statistically analyzed using the 'Chi Square test for Trend'. Results: This study highlighted some interesting findings such as the origin of Sino- atrial nodal artery from the second segment of right coronary artery in 3% of cases, double right marginal artery in 4% cases. Other variations such as Mouchet's posterior recurrent interventricular artery, origin of circumflex artery from the right coronary artery and abnormal communication between the terminal parts of right coronary artery and circumflex artery were each noticed in 1 % of cases. Conclusions: Coronary arteries and their branches are prone to variations in their course and morphology. Prior knowledge about this is important for the interpretation of coronary angiograms and surgical myocardial revascularization. The present work on normal and variant pattern of coronary arteries will help in gathering momentum to the already advancing research work in this field.

scholarly journals Correlation between the FINish diabetes risk score and the severity of coronary artery disease

2014 ◽  
Vol 71 (5) ◽  
pp. 474-480 ◽  
Author(s):  
Predrag Djuric ◽  
Zorica Mladenovic ◽  
Aleksandra Grdinic ◽  
Dragan Tavciovski ◽  
Zoran Jovic ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Waist Circumference ◽  
Coronary Arteries ◽  
Syntax Score ◽  
Group Iii ◽  
Vessel Disease ◽  
Group I ◽  
Group Ii ◽  
Artery Disease

Background/Aim. The FINish Diabetes RIsk SCore (FINDRISC) which includes age, body mass index (BMI), waist circumference, physical (in) activity, diet, arterial hypertension, history of high glucose levels, and family history of diabetes, is of a great significance in identifying patients with impaired glucose tolerance and a 10-year risk assessment of developing type 2 diabetes in adults. Due to the fact that the FINDRISC score includes parameters which are risk factors for coronary artery disease (CAD), our aim was to determine a correlation between this score, and some of its parameters respectively, with the severity of angiographically verified CAD in patients with stable angina in two ways: according to the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score and the number of diseased coronary arteries. Methods. The study included 70 patients with stable angina consecutively admitted to the Clinic of Cardiology, Military Medical Academy, Belgrade. The FINDRISC score was calculated in all the patients immediately prior to angiography. Venous blood samples were collected and inflammatory markers [erythrocyte sedimentation rate (ESR), leucocytes, C-reactive protein (CRP), total cholesterol, HDL cholesterol, triglycerides and fasting glucose] determined. Coronary angiography was performed in order to determine the severity of coronary artery disease according to the SYNTAX score and the number of affected coronary vessels: 1-vessel, 2-vessel or 3-vessel disease (hemodynamically significant stenoses: more than 70% of the blood vessel lumen). The patients were divided into three groups regarding the FINDRISC score: group I: 5-11 points; group II: 12-16 points; group III: 17-22 points. Results. Out of 70 patients (52 men and 18 women) enrolled in this study, 14 had normal coronary angiogram. There was a statistically significant positive correlation between the FINDRISC score and its parameters respectively (age, body mass index-BMI, waist circumference) and the severity of CAD according to the SYNTAX score (p < 0.001) and the number of diseased coronary arteries (p < 0.001). The patients with higher FINDRISC score (groups II and III) had more severe and extensive CAD according to the SYNTAX score than the group I. The odds ratio with 95% confidence intervals (CI) between the group III and the group I was 5.143 (95% CI 1.299-20.360, p = 0.002) and between the group II and the group I 5.867 (95% CI 1.590- 21.525, p = 0.007). There were no differences in odds ratio for multivessel disease according to FINDRISC score between the group II and the group III [1.141; (95% CI 0.348-3.734). In the group I mean SYNTAX score was 5.18, and more than 70% of patients had normal coronary angiogram. In the group II mean SYNTAX score was 17.06, and more than 70% of patients had 2-vessel disease and 3- vessel disease, and in the group III mean SYNTAX score was 18.89, and 2-vessel and 3-vessel disease had 36.36% and 31.82% patients, respectively. In multiple regression analysis, where SYNTAX score was dependent variable, and age, BMI, waist circumference, FINDRISC score were independent variables, we found that only FINDRISC score was independent predictor of SYNTAX score. Conclusion. The obtained results suggest a statistically significant correlation between the FINDRISC score and its parameters (age, BMI, waist circumference) and the severity of CAD according to the SYNTAX score and the number of diseased coronary arteries. The FINDRISC score may be useful in identifying patients at the high risk for coronary artery disease.

scholarly journals Predictive Performance of SYNTAX Score II in Patients With Left Main and Multivessel Coronary Artery Disease

2014 ◽  
Vol 78 (8) ◽  
pp. 1942-1949 ◽  
Author(s):  
Carlos M. Campos ◽  
David van Klaveren ◽  
Javaid Iqbal ◽  
Yoshinobu Onuma ◽  
Yao-Jun Zhang ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Predictive Performance ◽  
Syntax Score ◽  
Multivessel Coronary Artery Disease ◽  
Left Main ◽  
Syntax Score Ii ◽  
Artery Disease
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