Functional Complete Revascularization as Determined by an Optimized Scoring System After Revascularization: A Post Hoc Analysis from Multi‐Center PANDA III Trial

Figures

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  Figure 1. Representative Case of Different Scoring Systems. *Anatomic residual SYNTAX score (rSS): Wsegment is for segment weighing, Sclassic is for classic multiplication factor for severity in which a multiplication factor of 2 is used for non‐occlusive lesions and 5 for occlusive lesions. Adverse characteristics refer to the scores for lesion adverse characteristics. †Classic functional residual SYNATX score (c‐rFSS): classic WP refer to classic physiology weighting with a multiplication factor of 1 for lesions with post‐PCI QFR ≤0.80 and 0 for QFR >0.80; ‡Modified functional residual SYNATX score (m‐rFSS): modified WP refer to modified physiology weighting, with a multiplication factor of 1 for lesions with post‐PCI vessel QFR ≤0.80, 0.7 for QFR between 0.80 to 0.90, and 0 for QFR >0.90; Smodified is for modified multiplication factor for severity in which a multiplication factor of 5 is used for occlusive lesions, 2 for non‐occlusive lesions, and 1 for nonobstructive plaque. A patient yielded an anatomic rSS of 5, with a score of 0 for the left anterior descending (LAD) due to the diameter stenosis in LAD of less than 50% by visual assessment, and this patient was therefore stratified…

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  Figure 2. Study Flowchart. *A hierarchical listing based on the processes for QFR assessment was used to identify the exclusion reasons per patient. †Angiographic DICOM files should record the following parameters in order for 3D angiographic reconstruction and QFR computation, 1) distance source to the detector; 2) distance source to patient; and 3) imager pixel spacing and DICOM files were not analyzable if any of the 3 parameters were missing. ‡Complete revascularization was defined as anatomic rSS or classic/modified functional residual SYNTAX score of 0. c‐rFSS = classic residual functional SYNTAX score; DICOM = Digital Imaging and Communication in Medicine; m‐rFSS = modified residual functional SYNTAX score; rSS = residual SYNTAX score; other abbreviations as in Figure 1.

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  Figure 3. Reclassification by Classic Residual Functional SYNTAX Score and Modified Residual Functional SYNTAX Score. Anatomic CR (rSS = 0) was achieved in 644 (41.4%) patients, while 911 (58.6%) patients had anatomical IR (rSS >0). After the calculation of c‐rFSS, 36.9% of patients were unidirectionally reclassified from anatomic IR to functional CR (c‐rFSS = 0), while bidirectional reclassification was observed after the assessment of m‐rFSS with 31.4% of patients trans‐group from anatomic IR to functional CR (m‐rFSS = 0) and 6.6% of patients being reclassified from anatomic CR to functional IR (m‐rFSS >0). rFSS = residual functional SYNTAX score; other abbreviations as in Figures 1 and 2.

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  Figure 4. Time‐to‐event curves for 2‐year clinical outcomes stratified by Anatomic or Functional Revascularization Completeness. Kaplan‐Meier time‐to‐first event curves showing the 2‐year cumulative incidences of MACE and MACE excluding PMI by revascularization completeness based on modified residual functional SYNTAX score (A and B), anatomic residual SYNTAX score (C and D) and classic residual functional SYNTAX score (E and F), respectively. CI = confidence interval; HR = hazard ratio; MACE = major adverse composite endpoint; PMI = periprocedural myocardial infarction; other abbreviations as in Figures 1 and 2.

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  Figure 5. Comparison of Discrimination and Reclassification Ability of Models with rSS, c‐rFSS or m‐rFSS in Addition to Clinical Risk Factors. AUC, NRI, and IDI values of models with rSS, c‐rFSS, or m‐rFSS in addition to clinical risk factors were compared. *The reference model (model 1) included clinical risk factors only, including age, sex, hypertension, diabetes mellitus, hyperlipidemia, family history of CAD, history of myocardial infarction, and acute coronary syndrome. Model 2 included clinical risk factors plus rSS. Model 3 included clinical risk factors plus c‐rFSS. Model 4 included clinical risk factors plus m‐rFSS. AUC = area under the curve; NRI = net reclassification improvement; IDI = integrated discrimination index; other abbreviations as in Figures 1 and 2.