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.

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.

ApPropriateness of myocaRdial RevascularizatiOn assessed by the SYNTAX score II in a coUntry without cardiac Surgery faciliTies; PROUST study

2017 ◽  
Vol 227 ◽  
pp. 478-484 ◽  
Author(s):  
Bojan M. Stanetic ◽  
Miodrag Ostojic ◽  
Carlos M. Campos ◽  
Jelena Marinkovic ◽  
Vasim Farooq ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Myocardial Revascularization ◽  
Syntax Score ◽  
Syntax Score Ii

scholarly journals APPROPRIATENESS OF MYOCARDIAL REVASCULARIZATION ASSESSED BY SYNTAX SCORE II IN A CENTRE WITHOUT ON-SITE CARDIAC SURGERY

2015 ◽  
Vol 65 (10) ◽  
pp. A1583
Author(s):  
Bojan M. Stanetic ◽  
Miodrag Ostojic ◽  
Kurt Huber ◽  
Carlos Campos ◽  
Tamara Kovacevic-Preradovic ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Myocardial Revascularization ◽  
Syntax Score ◽  
Syntax Score Ii

Clinical Implications of the SYNTAX Study

2009 ◽  
Vol 4 (1) ◽  
pp. 48 ◽  
Author(s):  
Patrick Serruys ◽  
Scot Garg ◽  
◽  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
De Novo ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Syntax Score ◽  
Cerebrovascular Events ◽  
Percutaneous Coronary ◽  
Syntax Study ◽  
Better Than

Recent years have seen an ongoing debate as to whether coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI) is the most appropriate revascularisation strategy for patients with coronary heart disease (CAD). The Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) study was conducted with the intention of defining the specific roles of each therapy in the management of de novo three-vessel disease or left main CAD. Interim results after 12 months show that PCI leads to significantly higher rates of major adverse cardiac or cerebrovascular events compared with CABG (17.8 versus 12.4; p=0.002), largely owing to increased rates of repeat revascularisation. However, CABG was much more likely to lead to stroke. Interestingly, categorisation of patients by severity of CAD complexity according to the SYNTAX score has shown that there are certain patients in whom PCI can yield results that are comparable to, if not better than, those achieved with CABG. Careful clinical evaluation and comprehensive assessment of CAD severity, alongside application of the SYNTAX score, can aid practitioners in selecting the most suitable therapy for each individual CAD patient.

Risk reduction strategies: coronary revascularization before non-cardiac surgery

ESC CardioMed ◽  
2018 ◽  
pp. 2659-2663
Author(s):  
Fabio Rigamonti ◽  
Marco Roffi
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cardiac Surgery ◽  
Myocardial Revascularization ◽  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Metal Stents ◽  
Percutaneous Coronary ◽  
Reduction Strategies ◽  
Drug Eluting

An individualized, stepwise patient evaluation based on the degree of urgency of non-cardiac surgery, functional capacity, clinical presentation, and estimated cardiovascular stress related to surgery is recommended in order to assess the perioperative cardiovascular risk and optimize management. Myocardial ischaemia in the context of non-cardiac surgery may be related to acute coronary syndromes secondary to coronary plaque rupture or prolonged myocardial oxygen supply–demand imbalance. Randomized controlled trials have failed to show a benefit of routine preoperative prophylactic myocardial revascularization. Preoperative coronary angiography and, if appropriate, myocardial revascularization may be considered before high-risk surgery depending on symptom status and extent of ischaemia on non-invasive imaging. In patients requiring percutaneous coronary intervention, guidelines recommend new-generation drug-eluting stents over bare-metal stents, though randomized data are absent. While the minimal delay for a safe surgery following drug-eluting stent implantation remains to be defined, a time window of 5–6 weeks between percutaneous coronary intervention and surgery appears to be adequate in patients who cannot wait longer.

scholarly journals 497 Multimodality imaging of an evergreen conundrum: true or false aneurysm of the left ventricle?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E Garau ◽  
D Cocco ◽  
L Corda ◽  
V Palmisano ◽  
M Porcu ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
False Aneurysm ◽  
Diagnostic Yield ◽  
Systolic Function ◽  
Multimodality Imaging ◽  
Myocardial Revascularization ◽  
Mechanical Complication ◽  
Heart Team ◽  
Inferior Wall ◽  
Lv Aneurysm

Abstract In case of transmural necrosis following STEMI, the myocardial wall may develop a true or false aneurysm. While the former usually has a benign course, the latter has a propensity to rupture leading to an ominous prognosis. We report the case of a patient with a recent inferior STEMI complicated with LV aneurysm of the inferior wall, initially diagnosed as a false aneurysm. We describe the case of a 77-year-old man affected by hypertension, diabetes and AF. Two months before he experienced an inferior STEMI treated with late (>12 hours from symptoms onset) pPCI and implantation of a DES on the RCA and the postero-lateral branch. TTE showed a mildly reduced LV systolic function (EF 50%) due to akinesia of the inferior wall. The patient presented to the ED for recurrent syncopes at rest. Vital signs were unremarkable. Troponin and electrolytes were within normal range. ECG showed a normofrequent sinus rhythm and Q waves with persistent ST elevation in the inferior leads. TTE showed a suspected rupture of the inferior wall in the middle segment between the posterolateral papillary muscle and the mitral annulus. The rupture seemed to be contained by the pericardium so as to create a huge cavity communicating with the LV through an apparently small neck and refurnished with turbolent blood during the cardiac cycle. In the suspicion of a pseudoaneurysm ( an urgent cardiac CT was performed. CT showed an extraventricular cavity apparently contained by the pericardium with a narrow neck and a pericardial effusion of a high density liquid. A diagnosis of post-infarction pseudoaneurysm was made. The day after the patient was stable but TTE showed a mild increase of the size of the "pseudoaneurysm", hence the Heart Team referred the patient to the cardiac surgery department for an urgent repair. In the surgical room TOE displayed the large cavity rising from the inferior wall of the LV and the communication thorugh a large neck. The intraoperatory finding was, unexpectedly, a true aneurysm of the inferior wall. The redundant aneurysm was excised and the defect was succesfully closed with a bovine pericardium patch. No periprocedural complication was recorded and the postoperatory period was uneventful. The present case strikingly shows how a mechanical complication may develop in spite of myocardial revascularization. The high level of suspicion led to a strong effort to achieve a definite diagnosis. Multimodality imaging plays a pivotal role and is warranted since the initial evaluation with TTE may be inconclusive. CT has a high diagnostic yield but false positives may happen. MRI could have been more specific in our case, but the clinical evolution and the CT images led us to be confident in referring the patient to an urgent cardiac surgery. In conclusion, the non invasive differential diagnosis between true and false aneurysm still remains a modern challenge. Abstract 497 Figure. Multimodality imaging of a LV aneurysm

Sign in / Sign up

Export Citation Format

Share Document