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

Abstract Background Coronary artery disease (CAD) represents a leading cause of death worldwide. Coronary angiography represents the gold standard for diagnosis and selection of the best treatment for the patients with coronary artery disease; however some efforts have been made to predict CAD severity and complexity using non-invasive methods in order to identify the patients at high risk for cardiovascular events with less risk to the patients and before doing coronary angiography. Characterization of coronaryartery calcification by computed tomography known as Coronary artery calcium score (CACS) is equivalent to the total coronary atherosclerosis load and is proven to be related to angiographically significant lesions. Echocardiographic calcium score is now validated against non-coronary calcium by computed tomography with lower cost and no irradiation safety issues for reclassification of cardiac risk. Aim and Objectives to determine the correlation of echocardiography calcium score to severity of coronary artery disease. Patients and Methods Patients coming to Ain Shams University Hospitals for elective coronary angiography were subjected to histoty taking, examination, blood samples and echocardiographic examination. The echocardiographic calcium score was correlated with syntax score of their coronary angiography films. Also syntax score was divided into three groups; low risk ≤ 18, intermediate risk 18-27 and high risk groups >27. Results The study included 45 patients; 21 of which were males representing 46.6% of the participants. The mean age of the whole group was 52.7 ± 8.18. The mean final calcium score of the whole study group was 4.95±1.29. The mean syntax score of the whole study group was 22.88±12.3. There was significant difference between the three subgroups of the syntax score regarding total calcium score (p value 0.013) and highly significant difference between the numerical values of syntax score and final calcium score. Conclusion Echocardiographic calcium score is correlated to syntax score and the severity of coronary artery disease. The low cost, availability and the radiation free nature of echocardiography make it an attractive candidate for the on-going research regarding the non-invasive tools for prediction of CAD.

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AS-051 The Predictive Values in Patients With Multivessel coronary artery disease; The SYNTAX Score, EuroSCORE and Global Risk Classification for the Risk Stratification

The American Journal of Cardiology ◽

10.1016/j.amjcard.2012.01.056 ◽

2012 ◽

Vol 109 (7) ◽

pp. S27

Author(s):

Jeong Yoon Jang ◽

Duk-Woo Park ◽

Yong-Giun Kim ◽

Gyung-Min Park ◽

Ki-Won Hwang ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Risk Stratification ◽

Risk Classification ◽

Syntax Score ◽

Global Risk ◽

Multivessel Coronary Artery Disease ◽

Predictive Values ◽

Artery Disease

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Inflammatory and non-invasive vascular markers: The multimarker approach for risk stratification in coronary artery disease

Atherosclerosis ◽

10.1016/j.atherosclerosis.2008.02.019 ◽

2008 ◽

Vol 199 (1) ◽

pp. 3-11 ◽

Cited By ~ 88

Author(s):

Ignatios Ikonomidis ◽

Kimon Stamatelopoulos ◽

John Lekakis ◽

Georgia D. Vamvakou ◽

Dimitrios Th Kremastinos

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Risk Stratification ◽

Non Invasive ◽

Vascular Markers ◽

Artery Disease

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SYNTAX score-0 patients: risk stratification in nonobstructive coronary artery disease

Clinical Research in Cardiology ◽

10.1007/s00392-016-0998-5 ◽

2016 ◽

Vol 105 (11) ◽

pp. 901-911 ◽

Cited By ~ 10

Author(s):

Christoph Sinning ◽

Elvin Zengin ◽

Christoph Waldeyer ◽

Moritz Seiffert ◽

Renate B. Schnabel ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Risk Stratification ◽

Syntax Score ◽

Nonobstructive Coronary Artery Disease ◽

Artery Disease

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Outcomes of DES in Diabetic and Nondiabetic Patients with Complex Coronary Artery Disease after Risk Stratification by the SYNTAX Score

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s37239 ◽

2016 ◽

Vol 10 ◽

pp. CMC.S37239 ◽

Cited By ~ 1

Author(s):

Mohamed Loutfi ◽

Mohamed A. Sadaka ◽

Mohamed Sobhy

Keyword(s):

Coronary Artery Disease ◽

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Risk Stratification ◽

Coronary Intervention ◽

Syntax Score ◽

Repeat Revascularization ◽

Percutaneous Coronary ◽

Artery Disease

Diabetes mellitus (DM) increases the risk of adverse outcomes after coronary revascularization. Controversy persists regarding the optimal revascularization strategy for diabetic patients with multivessel coronary artery disease (MVD). Aim The aim of this study was to assess the outcomes of drug-eluting stent (DES) insertion in DM and non-DM patients with complex coronary artery disease (CAD) after risk stratification by the percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score. Methods and Results We performed multivessel percutaneous coronary intervention (PCI) for 601 lesions in 243 DM patients and 1,029 lesions in 401 non-DM patients. All included patients had MVD and one or more lesions of type B2/C. The two-year outcomes and event rates were estimated in the DM and non-DM patients using Kaplan–Meier analyses. The baseline SYNTAX score was ≤22 in 84.8% vs. 84%, P = 0.804, and 23-32 in 15.2% vs. 16%, P = 0.804, of the DM and non-DM patients, respectively. The number of diseased segments treated (2.57 ± 0.75 vs. 2.47 ± 0.72; P = 0.066) and stents implanted per patient (2.41 ± 0.63 vs. 2.32 ± 0.54; P = 0.134) were similar in both groups. After a mean follow-up of 642 ± 175 days, there were no differences in the major adverse cardiac and cerebrovascular events (MACCE; 26.7% vs. 20.9%; P = 0.091), composite end point of all-cause death/myocardial infarction (MI)/stroke (12.3% vs. 9%; P = 0.172), individual MACCE components of death (3.7% vs. 3.2%; P = 0.754), MI (6.6% vs. 4%; P = 0.142), and absence of stroke in the DM and non-DM patients. An increased need for repeat revascularization was observed in DM patients (18.5% vs. 10.2%; P = 0.003). In the multivariate analysis, DM was an independent predictor of repeat revascularization (hazard ratio: 1.818; 95% confidence interval: 1.162-2.843; P = 0.009). Conclusions DES implantation provides favorable early and mid-term results in both DM and non-DM patients undergoing PCI for complex lesions. After a mean follow-up of two years, DM and non-DM patients with complex CAD treated by PCI using new-generation DES showed no differences with regard to MACCE and other secondary end points. However, higher rates of ischemia-driven repeat revascularization were observed in DM patients.

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