Original title: Reasonable incomplete revascularisation after percutaneouscoronary intervention: the SYNTAX Revascularisation Index. Reference: Philippe Généreux et al. EuroIntervention 2014;10-online publish-ahead-of-print.
While the absolute amount of residual disease after coronary angioplasty is associated with poor prognosis, the proportion of treated coronary disease modifying the prognosis is still to be determined. This study attempted to quantify the proportion of coronary disease treated by angioplasty and assessed their impact on the results using a new instrument, the rate of revascularization SYNTAX. Residual baseline SYNTAX score was calculated in 2618 patients registered in the ACUITU study. SYNTAX revascularization index is calculated using the following formula: SYNTAX revascularization index = (1-[residual SYNTAX / basal SYNTAX]) × 100. Results were examined according to 3 groups of revascularization rate SYNTAX: 100% (complete revascularization), 50-99% and <50%. SYNTAX average revascularization rate was 85%, with 1079 patients (41.2%) at 100% rate, 907 patients (34.6%) between 50 and 99% rate and 632 patients (24.1%) at <50% rate.
At one year, adverse events (including death) were inversely proportional to SINTAX revascularization SYNTAX. In the ROC curves, the cutoff rate of SYNTAX revascularization forecast with the best accuracy for predicting death was <80% (area under the curve of 0.60, IC 95% 0.53 to 0.67, p <0.0001). In the multivariate analysis, the new index was an independent predictor of mortality at one year ([HR] 2.17, IC 95%: 1.05-4.35, p = 0.03) and when compared with other scores it was superior in the ability to predict one-year mortality.
Conclusion
SYNTAX revascularization index is a new method to quantify the proportion of coronary heart disease treated with angioplasty. Since their correlation with mortality, the new tool could be useful for measuring the degree of revascularization, being ≥80% index a reasonable target.
Editorial comment
The baseline, residual, and SYNTAX index have different meanings and play different roles in daily clinical practice. Baseline score can be used to predict the outcome before revascularization and help decide between angioplasty or surgery, while the residual SYNTAX and SYNTAX index give us prognostic information after the procedure but also assist as a guide about the amount of revascularization or in other words, how much incomplete revascularization we can tolerate.
All this needs to be validated in other studies that include more patients with multivessel since the average basal SYNTAX of ACUITY study was only 9. Calculating a score prior to the procedure and then again calculating the score and integrate those results in a formula, may be useful in a particular patient, but very challenging in daily practice
SOLACI