Clinical Research
Interventional Cardiology
Functional SYNTAX Score for Risk Assessment in Multivessel Coronary Artery Disease

https://doi.org/10.1016/j.jacc.2011.06.020Get rights and content
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Objectives

This study was aimed at investigating whether a fractional flow reserve (FFR)-guided SYNTAX score (SS), termed “functional SYNTAX score” (FSS), would predict clinical outcome better than the classic SS in patients with multivessel coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI).

Background

The SS is a purely anatomic score based on the coronary angiogram and predicts outcome after PCI in patients with multivessel CAD. FFR-guided PCI improves outcomes by adding functional information to the anatomic information obtained from the angiogram.

Methods

The SS was prospectively collected in 497 patients enrolled in the FAME (Fractional Flow Reserve versus Angiography for Multivessel Evaluation) study. FSS was determined by only counting ischemia-producing lesions (FFR ≤0.80). The ability of each score to predict major adverse cardiac events (MACE) at 1 year was compared.

Results

The 497 patients were divided into tertiles of risk based on the SS. After determining the FSS for each patient, 32% moved to a lower-risk group as follows. MACE occurred in 9.0%, 11.3%, and 26.7% of patients in the low-, medium-, and high-FSS groups, respectively (p < 0.001). Only FSS and procedure time were independent predictors of 1-year MACE. FSS demonstrated a better predictive accuracy for MACE compared with SS (Harrell's C of FSS, 0.677 vs. SS, 0.630, p = 0.02; integrated discrimination improvement of 1.94%, p < 0.001).

Conclusions

Recalculating SS by only incorporating ischemia-producing lesions as determined by FFR decreases the number of higher-risk patients and better discriminates risk for adverse events in patients with multivessel CAD undergoing PCI. (Fractional Flow Reserve versus Angiography for Multivessel Evaluation [FAME]; NCT00267774)

Key Words

coronary angiography
coronary artery disease
fractional flow reserve
percutaneous coronary intervention
risk assessment

Abbreviations and Acronyms

AUC
area under the curve
CABG
coronary artery bypass graft
CAD
coronary artery disease
CI
confidence interval
FFR
fractional flow reserve
FSS
functional SYNTAX score
IDI
integrated discrimination improvement
MACE
major adverse cardiac event(s)
MI
myocardial infarction
PCI
percutaneous coronary intervention
ROC
receiver-operator characteristic
SS
SYNTAX score

Cited by (0)

Dr. De Bruyne has received research grants from the Meijer Lavino Foundation for Cardiac Research. Dr. Pijls has received an institutional research grant for the Catharina Hospital Eindhoven from St. Jude Medical. Dr. Fearon has received an institutional research grant from St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.