Relationship of SYNTAX Score to Myocardial Ischemia as Assessed on Myocardial Perfusion Imaging

Abstract

Background: Although the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score is used to characterize coronary anatomy based on 9 anatomic criteria such as lesion location and complexity, the relationship between SYNTAX score and myocardial ischemia has yet to be elucidated. Methods and Results:A total of 158 consecutive patients with suspected or known coronary artery disease (CAD), who underwent both 99 m Tc-sestamibi single-photon emission computed tomography (SPECT) and coronary angiography, were evaluated. Stress SPECT was assessed using a 17-segment model, and the percentage of the myocardial defect scores (DS) was calculated. In 37 patients with intermediate-high SYNTAX scores (>22), the number of men and the prevalence of multi-vessel CAD were significantly higher, and the % stress and ischemic DS were significantly greater than in 121 patients with low SYNTAX scores (≤22). Coronary risk factors, however, were similar between the 2 groups. The % stress and ischemic DS significantly correlated with SYNTAX score. In patients with a low SYNTAX score, % stress and ischemic DS also significantly correlated with the SYNTAX score, whereas no such correlation was observed in the intermediate-high SYNTAX score group.Conclusions: SYNTAX score correlated well with myocardial ischemia as assessed on stress SPECT in general. The higher the SYNTAX score, however, the less clear was the correlation with the extent of myocardial ischemia. (Circ J 2013; 77: 2772 -2777

Prediction of Left Main or 3-Vessel Disease Using Myocardial Perfusion Reserve on Dynamic Thallium-201 Single-Photon Emission Computed Tomography With a Semiconductor Gamma Camera

“…The radiation exposure is greater, however, with 201 Tl than 99 m Tc perfusion tracers; the reported average radiation exposure per study reported by the International Commission on SYNTAX score, had % ischemic difference score <10%; all 4 presented with left main or 3-vessel CAD. 9 In those 4 patients the severity of myocardial ischemia may have been low. The major limitations of MPI are its spatial relativity in perfusion defect analysis.…”

Predictive Performance of SYNTAX Score II in Patients With Left Main and Multivessel Coronary Artery Disease

“…In the latest trial, functional lesion assessment was added to improve late PCI outcomes and it is plausible that this approach may improve the discrimination of anatomical SS. 38 In the PCI cohort of the CREDO-Kyoto registry patients were treated mainly with first-generation drug-eluting stent (DES). It is possible that its performance will be affected by the use of newer generation DES.…”

Prognostic value of SYNTAX score based on coronary computed tomography angiography

“…A recent randomized clinical trial reported that among patients with complex CAD (LM or 3-vessel disease), the low (0-22) SYNTAX score group showed no significantly different adverse cardiac and cerebrovascular event (MACCE) rates between treatment groups (CABG vs. PCI). In contrast, patients with intermediate (23)(24)(25)(26)(27)(28)(29)(30)(31)(32) or high SYNTAX scores (≥33) had significantly higher MACCE rates with PCI than with CABG [16]. Based on the overall results of this trial at 5 years, CABG should remain the standard of care for patients with a high or intermediate SYNTAX score, while PCI is an acceptable alternative in patients with lesscomplex disease [16].…”