Editorial
Does the SYNTAX score get on your nerves? Practical considerations on how and when avoiding it to maximize its usefulness with no waste of time

https://doi.org/10.1016/j.ijcard.2012.01.049Get rights and content

Abstract

The Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) score is a useful tool to guide decision-making in patients undergoing three-vessel disease and left main percutaneous coronary intervention. However, someone perceives the SYNTAX score as a labor-intensive surrogate with no added utility over clinical judgment and technical experience. We aimed at reviewing the current limitations of the SYNTAX score and provided practical considerations on how and when this angiographic tool should be used with the goal in mind to maximize its usefulness in the catheterization laboratory.

Section snippets

When SYNTAX score is not enough: commonly encountered pitfalls and limitations of SYNTAX score use in routinary practice

The SYNTAX score was originally introduced to facilitate discussion among cardiologists and surgeons regarding patients amenable to either PCI or CABG and therefore enrollable in the SYNTAX trial [18]. Following the presentation of the trial results, the score has gained a broader significance as an aid for decision-making and entered daily practice in many catheterization laboratories worldwide, with the endorsement of key opinion leaders in the field. However, a number of issues remain, which

Practicalities and considerations for skipping SYNTAX score calculation in selected cases

Among the key factors that have led to the development of the SYNTAX score there is the notion that even in patients with complex angiographic presentation, such as those with 3VD, a scale of complexity exists that distinguishes patients at lower risk (i.e., those amenable to spot stenting in three separate vessels) and patients at higher risk (i.e., those with chronic total occlusions of the left circumflex and the right coronary artery and diffuse, critical disease of the left anterior

Conclusions

The SYNTAX score is a nice step forward in the objectification of clinical decisions and no one should be so self-confident as to favor his own opinion as the only effective prognostic parameter. However, the SYNTAX score is imperfect, as it does not rely on clinical and functional information and, therefore, should not be idealized as a dogma. While time and variability issues should not contraindicate the use of the SYNTAX score, these problems can be addressed by calculating the score only

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