Department of Cardiology, S. Giovanni Battista Molinette Hospital, Turin, Italy.
J Cardiovasc Med (Hagerstown). 2012 Jun;13(6):368-75. doi: 10.2459/JCM.0b013e3283536adc.
To investigate the relationship between classic SYNTAX and functional SYNTAX score guided by fractional flow reserve (FFR).
SYNTAX score predicts clinical outcome after percutaneous coronary intervention in patients with multivessel coronary artery disease (CAD), based on data from angiography alone. However, in the clinical setting, decision-making on myocardial revascularization should be guided by reliable demonstration of inducible ischemia, as detected by FFR.
FFR was collected in all 50-90% angiographic stenoses of 39 consecutive patients with stable multivessel CAD. SYNTAX score was calculated as usually described in SYNTAX group's reports. A functional SYNTAX (F-SYNTAX) score was determined by only considering ischemia-producing lesions (FFR ≤ 0.80). The two scores were compared with correlation, Bland-Altman and agreement tests.
FFR was measured in 97 lesions, with a median value of 0.82±0.10. In the 50-70% and 70-90% category stenoses, FFR was greater than 0.80 in 68 and 16% of cases, respectively. F-SYNTAX was systematically inferior to SYNTAX score, with a median difference of 8.4±7.4 (P<0.05). The correlation between the two methods was globally weak (r=0.621, rho=0.563; P<0.001). After determining F-SYNTAX score, more than 30% of the patients moved to a lower-risk tertile group (P=0.003). No clinical and angiographic differences were found between patients whether or not reclassified in lower-risk tertiles with F-SYNTAX score.
In patients with multivessel CAD, implementation of SYNTAX score with FFR seems to be a more rational approach for revascularization. F-SYNTAX score reclassifies a significant proportion of patients to a lower-risk profile, thus leading to a possible change of therapeutic strategy.
研究基于血流储备分数（FFR）的经典 SYNTAX 评分和功能 SYNTAX 评分之间的关系。
SYNTAX 评分基于单纯血管造影数据预测多支血管病变（CAD）患者经皮冠状动脉介入治疗后的临床结局。然而，在临床实践中，心肌血运重建的决策应通过 FFR 可靠地显示可诱导缺血来指导。
对 39 例稳定型多支 CAD 患者的所有 50-90%的血管造影狭窄处采集了 FFR。SYNTAX 评分按照 SYNTAX 组报告中的通常方法计算。仅考虑产生缺血的病变（FFR≤0.80）确定功能 SYNTAX（F-SYNTAX）评分。比较两种评分的相关性、Bland-Altman 检验和一致性检验。
97 处病变测量了 FFR，中位数为 0.82±0.10。在 50-70%和 70-90%狭窄分类中，FFR 大于 0.80 的分别占 68%和 16%。F-SYNTAX 评分明显低于 SYNTAX 评分，中位数差异为 8.4±7.4（P<0.05）。两种方法的相关性整体较弱（r=0.621，rho=0.563；P<0.001）。确定 F-SYNTAX 评分后，超过 30%的患者转移到风险较低的 tertile 组（P=0.003）。F-SYNTAX 评分重新分类后，低风险 tertile 患者的临床和血管造影差异无统计学意义。
在多支 CAD 患者中，SYNTAX 评分结合 FFR 似乎是一种更合理的血运重建方法。F-SYNTAX 评分重新分类了相当一部分患者到风险较低的谱，从而可能改变治疗策略。
