1 - Individualized Assessment for Percutaneous or Surgical-Based Revascularization

Abstract

(1) Changes in the demographics of patients who present in need of revascularization, advances in percutaneous and surgical revascularization techniques, and results from contemporary studies of percutaneous versus surgical revascularization have made it essential that patients be assessed as individuals prior to selection of a treatment strategy. (2) Risk stratification plays an important role in the assessment of patients undergoing revascularization. (3) Clinical tools used to assist the heart team in risk stratifying patients and deciding the most appropriate revascularization modality can be broadly divided into assessments based on clinical comorbidities, coronary anatomy, or a combination of the two. (4) Clinical tools based on the Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) trial have evolved from purely anatomic factors (anatomic SYNTAX score) to anatomic factors augmented by clinical variables (culminating in the development of the SYNTAX score II) and tools to assess a level of reasonable incomplete revascularization that would not have an adverse effect on long-term morbidity and mortality (residual SYNTAX score). Validation of many of these newly developed clinical tools is ongoing. (5) Clinical and anatomic factors have an impact on short- and long-term morbidity and mortality following surgical or percutaneous revascularization and must be considered by the heart team in open dialogue with the patient during the decision-making process.