8^th Global Cardiologists and Echocardiography Annual Meeting

Biography

Biography: Alfredo E Rodriguez

Abstract

Recently, an angiographic score was introduced in clinical practice to stratified different levels of risk after PCI. The SYNTAX score (SS) classified patients in three different risk levels. Patients allocated with low SS could be equally treated with either PCI or CABG, whereas those with intermediate or high SS were better off with CABG. However, using original SS each coronary lesion with a diameter stenosis ≥50% in vessels ≥1.5 mm was scored. In contrast, in ERACI IV study, which included patients with multiple vessel disease and unprotected left main stenosis treated with 2nd generation DES, we used a revascularization strategy during PCI where operators were advised to only treat lesions ≥ than 70% in a ≥ 2.0mm reference vessel; therefore, no intermediate lesions should be treated and severe stenosis in vessels ≤ 2.0 mm was discouraged as well. If we recalculated SS using the above-mentioned operators' advices all intermediate lesions were not scored and severe stenosis in vessels < 2.0 mm were excluded for the analysis; after this new scoring, the original SS dropped from 27.7 to 22. More over after this new scoring in ERACI IV, low SS rose to 54.8%, intermediate dropped to 27.9% and only 17.2% of ERACI’s patients scored a high SS. At 24.5 months of follow up, MACCE rate was only 6.7%, composite of death/MI and stroke was 3.6% and unplanned new revascularization 4%. In conclusion, if we performed a SS scoring only severe stenosis in vessels with a reference diameter ≥ 2.0 mm would allow a more rational assessment of coronary anatomy which was associated with low events rate at 2 years of follow up.