• Significant coronary stenosis:– LMCA stenosis ≥50% luminal diameter narrowing in the

worst view by visual assessment– Epicardial non-LMCA stenosis ≥70% luminal diameter

narrowing in the worst view by visual assessment

• “Borderline” coronary stenosis:– Epicardial non-LMCA stenosis 50-60% luminal diameter

narrowing

Patel, et al. JACC 2012; 59:

masculino 51 AÑOSORIGEN UNICO DE AMBAS CORONARIAS

39 años, Masculino.Tabaco. IAM con elevación ST cara inferior

Archivos: Hospital Metropolitano Vivan Pellas

Archivos: Hospital Metropolitano Vivan Pellas

STENT ENDEAVOR RESOLUTE3.5/30 mm

From: WSJ July 6, 2011

Uncertainty about “Uncertain”

The Synergy between Percutaneous Coronary

Intervention with TAXUS and Cardiac Surgery:

The SYNTAX Study

Primary Endpoint Results at One Year in the Randomized Cohort

Patrick W. Serruys MD PhDFriedrich W. Mohr MD PhD

On behalf of the SYNTAX investigators

Conflicts of Interest: None

Patient ProfilingLocal Heart team (surgeon & interventional cardiologist) assessed each patient in regards to :

• Patient’s operative risk (EuroSCORE & Parsonnet score)

• Coronary lesion complexity (Newly developed SYNTAX score)

• Goal: SYNTAX score to provide guidance on optimal revascularization strategies for patients with high risk lesions

Sianos et al, EuroIntervention 2005;1:219-227Valgimigli et al, Am J Cardiol 2007;99:1072-1081Serruys et al, EuroIntervention 2007;3:450-459

BARI classification of coronary segmentsLeaman score, Circ 1981;63:285-299Lesions classification ACC/AHA , Circ 2001;103:3019-3041Bifurcation classification, CCI 2000;49:274-283CTO classification, J Am Coll Cardiol 1997;30:649-656

No. &

Location

of lesion Left

Main

Tortuosity

3 VesselThrombus

BifurcationCTO

Calcification

SYNTAX

SCORE

Dominance

Patient 1

Patient 1 Patient 2

Patient 2

SYNTAX SCORE 21 SYNTAX SCORE 52

LCx 70-90%

LAD 70-90%

RCA2 70-90%

RCA3 70-90%

LM 99%

LCx 100%

LAD 99%

RCA 100%

There is ‘3-vessel disease’ and ‘3-vessel disease’

Appropriate Use Criteria for Coronary Revascularization Focused Update 2012

Endorsed by:

Date of download: 9/24/2014

Copyright © The American College of Cardiology. All rights reserved.

From: ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography

J Am Coll Cardiol. 2012;59(9):857-881. doi:10.1016/j.jacc.2011.12.001

Method of Revascularization of Multivessel Coronary Artery Disease

A = appropriate; CABG = coronary artery bypass grafting; CAD = coronary artery disease; CTO = chronic total occlusion; I = inappropriate; LAD = left anterior descending artery; PCI = percutaneous coronary intervention; SYNTAX = Synergy Between PCI With TAXUS and Cardiac Surgery; U = uncertain.

Figure Legend:

MasculinoDiabético72 años

1. EN SINDROMES CORONARIOS AGUDOS LA INTERVENCION PERCUTANEA ES EL METODO DE REVASCULARIZACION DE ELECCION.

2. EL BY PASS DE URGENCIA ES UNA INDICACION LIMITADA Y MUY RARA EN CONTEXTO ACTUAL

3. LA INTERVENCION CORONARIA PERCUTANEA ES UNA ESTRATEGIA IDEAL PARA LA REVASCULARIZCION EN LA MAYOR PARTE DE LOS ESCENARIOS DEL PACIENTE ESTABLES. BY PASS ES MEJOR EN ANATOMIAS MAS COMPLEJAS.

4. LA ANGIOGRAFIA CORONARIA Y LA MEDICION DE FFR OFRECE UNA VALORACION MAS COMPLETA DE LA ISQUEMIA MIOCARDICA Y PERMITE RECLASIFICAR LOS PACIENTES PARA ADECUAR LA ESTRATEGIA DE REVASCULARZACION