LETTER TO THE EDITOR
Residual SYNTAX score II: A combination of the assessment of the revascularization degree and the clinical evaluation after percutaneous coronary intervention Marouane Boukhris a,⇑, Farouk Abcha a, Salvatore D. Tomasello b, Simona Giubilato b, Salvatore Azzarelli b, Alfred R Galassi c,d a Cardiology Department, Abderrahmen Mami Hospital, Ariana, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis; b Cardiology Division, Cannizzaro Hospital, Catania; c Department of Clinical and Experimental Medicine, University of Catania, Catania; d University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich a
Tunisia Italy d Switzerland b,c
W
e would like to thank Dr Cerit for his valu-
able comments on our paper [1]. Firstly, he pointed out, the importance of SYNTAX score II (SS II), integrating anatomical SYNTAX score (SS) with clinical characteristics and allowing an individualized prediction of long-term mortality [2,3]. Indeed, this latter score has become the gold standard for a better risk stratification in coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI) [4]. We have shown that SS II was able to predict clinical events in not only ideal stable patients, but also in an unrestricted, real world population of patients with Acute coronary syndrome (ACS) and severe CAD [3-vessel disease and/or left main (LM) stenosis] referred to cathlab [1].
Secondly, although some variables included in SS II are still the same following revascularization (age, sex, peripheral arterial disease, and chronic obstructive pulmonary disease), others could be modified by PCI [creatinine clearance, left ventricular ejection fraction (LVEF), anatomical SS, and unprotected LM stenosis] [2]. Indeed, patients could experience contrast induced nephropathy, LVEF might be either improved or impaired according to the success of the procedure and coronary lesions will be treated with the aim to achieve complete revascularization or the lowest possible residual SS (rSS). In our study, 100 patients were enrolled; LM stenosis was observed in 19% and LVEF was impaired in 35% of cases. Baseline median of SS and SS II were 26 (range, 7–47) and 29 (range,
Disclosures: Authors have nothing to disclose with regard to commercial support Available online 23 November 2017
⇑ Corresponding author at: Cardiology Department, Abderrahmen Mami Hospital, Ariana, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis 2008, Tunisia. E-mail address:
[email protected] (M. Boukhris).
P.O. Box 2925 Riyadh – 11461KSA Tel: +966 1 2520088 ext 40151 Fax: +966 1 2520718 Email:
[email protected] URL: www.sha.org.sa
1016-7315 Ó 2017 The Authors. Production and hosting by Elsevier B.V. on behalf of King Saud University. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer review under responsibility of King Saud University. URL: www.ksu.edu.sa https://doi.org/10.1016/j.jsha.2017.11.003
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BOUKHRIS ET AL RESIDUAL SYNTAX SCORE II: A COMBINATION OF THE ASSESSMENT OF THE REVASCULARIZATION DEGREE AND THE CLINICAL EVALUATION AFTER PERCUTANEOUS CORONARY INTERVENTION
14–59), respectively [1]. Although all LM lesions were treated, complete revascularization was only achieved in twothirds of patients with a median rSS of 4 (range, 2–18.5) [1]. Following PCI, CIN (contrast induced nephropathy) incidence was 9% in our study, although LVEF either significantly increased or decreased (>5%) in 12% and 1% of cases, respectively. Therefore as suggested, we calculated residual SS II; the median was 13 (range, 6–19). Interestingly, residual SS II 13 also predicted major adverse cardiac and cerebrovascular events occurrence at 1 year outcome (hazard ratio, 1.93; 95% confidence interval: 1.18–6.81; p = 0.037). In conclusion, we agree that residual SS II could be of interest to predict midterm outcome in complex ACS patients. Indeed, in addition to ‘‘as complete as possible’’ revascularization, the preservation or the improvement of clinical status (particularly renal function and LVEF) is impor-
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tant to achieve better cardiovascular outcome in this high risk subset of patients.
References [1] Salvatore A, Boukhris M, Giubilato S, Tomasello SD, Castaing M, Giunta R, et al.. Usefulness of SYNTAX score II in complex percutaneous coronary interventions in the setting of acute coronary syndrome. J Saudi Heart Assoc 2016;28:63–72. [2] Farooq V, van Klaveren D, Steyerberg EW, Meliga E, Vergouwe Y, Chieffo A, et al.. Anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention for individual patients: development and validation of SYNTAX score II. Lancet 2013;381:639–50. [3] Campos CM, van Klaveren D, Iqbal J, Onuma Y, Zhang YJ, Garcia-Garcia HM, et al.. Predictive performance of SYNTAX score II in patients with left main and multivessel coronary artery disease. Circ J 2014;78:1942–9. [4] Escaned J, Collet C, Ryan N, De Maria GL, Walsh S, Sabate M, et al.. Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with de novo three vessel disease: 1-year results of the SYNTAX II study. Eur Heart J 2017;38:3124–34.
LETTER TO THE EDITOR
J Saudi Heart Assoc 2018;30:158–159
