Evolution of the SYNTAX score (I, II, and II 2020): Development, application, and limitations in everyday clinical practice

Résumé fourni par la source

Surgical myocardial revascularization is the gold standard for myocardial revascularization in chronic coronary syndrome (CCS). The first randomized trials comparing bare metal stent (BMS) implantation and aorto-coronary bypass graft surgery (CABG) resulted in similar mortality and myocardial infarction rate, and a lower rate of repeat revascularization after CABG compared to BMS implantation, directing the development of drug-eluting stents (DES) with the lower rate of clinical restenosis. Over the years, there was a need for objective assessment and calculation of the risks and benefits of both surgical and percutaneous myocardial revascularization, and for determining whether one of these methods is preferable or equipoise for a specific patient. The SYNTAX score was used to quantify the complexity of coronary stenoses in a patient with CCS. However, two major flaws of the SYNTAX score I, (1) the absence of the assessment of functional significance of coronary stenosis, and (2) the absence of clinical variables that may influence perioperative mortality rate, were partially overcome with the development of SYNTAX score II. SYNTAX score II included clinical variables that showed the greatest association with mortality (age, creatinine clearance, left ventricular ejection fraction, unprotected left main coronary artery disease, female gender, peripheral vascular disease, and chronic obstructive pulmonary disease). SYNTAX score II 2020 represents SYNTAX score II with the addition of a 10-year clinical follow-up on mortality. The SYNTAX score II and II 2020 may change recommendations for myocardial revascularization based solely on SYNTAX score I. This review focuses on the development of these scores, their accuracy, predictive value, and limitations in practical applications in an individual patient with CCS, with a primary objective to disclose the development of SYNTAX scores I, II, and II 2020, their prognostic value, and limitations in routine clinical application in a process of making a recommendation for optimal myocardial revascularization in a patient with CCS.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.