Prognostic Value of the Residual SYNTAX Score After Functionally Complete Revascularization in ACS
Yuhei Kobayashi, Jacob Lønborg, Andy Jong, Takeshi Nishi, Bernard De Bruyne, Dan Eik Høfsten, Henning Kelbæk, Jamie Layland, Chang-Wook Nam, Nico H.J. Pijls, Pim A.L. Tonino, Julie Warnøe, Keith G. Oldroyd, Colin Berry, Thomas Engstrøm, William F. Fearon and on behalf of the DANAMI-3-PRIMULTI, FAME, and FAMOUS-NSTEMI Study Investigators
Concept of Functionally Complete Revascularization in Acute Coronary Syndromes
In patients presenting with acute coronary syndromes (ACS) and multivessel disease, 3 management strategies exist after the revascularization of the culprit vessel. First, one can treat the nonculprit disease medically (culprit-only revascularization). Second, one can treat only nonculprit lesion(s) with positive fractional flow reserve (FFR) (functionally complete revascularization). Third, one can treat all nonculprit stenoses based on the angiogram (angiographic complete revascularization). As shown in previous studies, complete revascularization of nonculprit disease leads to a better prognosis compared with culprit-only revascularization, in patients presenting with acute coronary syndromes and multivessel disease. In this study, we found that the extent of residual coronary disease after functionally complete revascularization is not prognostically important, adding support to the concept that functionally complete revascularization is the best mode of revascularization in this setting. LAD = left anterior descending artery; LCx = left circumflex artery; MACE = major adverse cardiac events; PCI = percutaneous coronary intervention; RCA = right coronary artery; RSS = residual SYNTAX score; Rx = treatment.