Key result
Integrating the Syntax Score II 2020 with FFR reclassified 40% of 'CABG better' patients into the CABG-PCI equipoise category (P<0.001), with both groups showing similar survival rates.
Why the study?
The study investigated the prognostic value of the Syntax Score II 2020 corrected for flow-limiting lesions and its ability to improve treatment selection by benefit prediction in left main or multivessel disease.
Does the functional Syntax Score II 2020 (integrated with FFR) improve risk stratification and therapeutic guidance compared to the anatomic Syntax Score II 2020 in patients with left main or multivessel disease?
Cohort (n=1,274)
Does the functional Syntax Score II 2020 (integrated with FFR) improve risk stratification and therapeutic guidance compared to the anatomic Syntax Score II 2020 in patients with left main or multivessel disease?
Absolute Event Rate: 81.7% vs 69.2%
p-value: p=<0.001
Integrating FFR physiology with the Syntax Score II 2020 reclassifies a significant proportion of patients from CABG-preferred to CABG-PCI equipoise without compromising survival.
The present study investigates the prognostic value of the Syntax Score II 2020 corrected for flow-limiting lesions and its ability to better address treatment by benefit prediction among patients with left main or multivessel disease. We analyzed 1274 patients from the HALE-BOPP cohort and integrated the Syntax Score II 2020 with the result of the fractional flow reserve (FFR) evaluation. Absolute risk difference (ARD) between surgical and percutaneous revascularization was calculated for anatomic and functional Syntax Score II 2020 predicted mortality. The ARD allowed to stratify the population into two large categories: “coronary artery bypass graft (CABG) better” with ARD ≥ 4.5% and “CABG–percutaneous coronary intervention (PCI) equipoise” with ARD < 4.5%. The mean global anatomical Syntax Score was 15.5 ± 9.2, whereas the functional one was 9.5 ± 10 (p < 0.01). Using the anatomic Syntax Score II 2020, 881 patients had a CABG-PCI equipoise. This number increased to 1041 after considering only flow-limiting lesions by FFR (p < 0.001); therefore, 40% of CABG better patients were reclassified within the CABG-PCI equipoise category. Kaplan–Maier curves showed similar actual survival rates for patients originally with CABG-PCI equipoise and those reclassified, in both cases higher than those from CABG better patients (p < 0.01). The integration between Syntax Score II 2020 and physiology is feasible, and merging clinical, anatomic and functional data allows for better risk prediction and therapeutic guidance.
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Scala et al. (2023) conducted a cohort in Left main or multivessel disease (n=1,274). Functional Syntax Score II 2020 (integrated with FFR) vs. Anatomic Syntax Score II 2020 was evaluated on CABG-PCI equipoise classification (p=<0.001). Integrating the Syntax Score II 2020 with FFR reclassified 40% of 'CABG better' patients into the CABG-PCI equipoise category (P<0.001), with both groups showing similar survival rates.
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