Paradigm Has Already Shifted to Ischemia-Guided Functional Approach

Abstract

The anatomic Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) score is a stratification score illustrating the complexity of angiographic stenosis. It was considered a surrogate for poor prognosis after percutaneous coronary intervention (PCI).1 Accordingly, in patients with a high baseline SYNTAX score (bSS) requiring coronary revascularization, coronary artery bypass graft surgery was chosen over PCI in the current guidelines.2,3 The mechanism by which bSS is a good surrogate for long-term prognosis is evident. Patients with a high bSS compared with those with a low bSS have more complex comorbidities such as old age, diabetes mellitus, multiple stenoses, and low left ventricular function. Subsequently, they receive more complex procedures using multiple stents and devices. Since the SYNTAX score II was revised by taking into consideration clinical risk factors, the function of the scoring model in choosing between PCI and coronary artery bypass graft surgery and prognosis prediction has improved.4 Article see p 141 The residual SYNTAX score (rSS), which is a variant of the SYNTAX score, was recently constructed to represent the extent of untreated coronary lesions after revascularization treatment. In the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) study, comprising patients with acute coronary syndrome, there was a stepwise increase in the rate of major adverse cardiac events, including death, myocardial infarction, and unplanned revascularization, in patients with an rSS of 0 (16.3%), >0 to 2 (18.0%), >2 to 8 (20.0%), and >8 (22.4%).5 In particular, for patients with …