Leveraging QFR and SYNTAX score II 2020 to guide PCI versus CABG decisions in multivessel CAD – broadening QFR’s utility

There is a greater need than ever to tailor revascularisation appropriately, taking into consideration a patient’s comorbidities, coronary anatomy, personal preferences, and individual perception of risk. The multidisciplinary Heart Team (HT) approach has been espoused and deployed for multiple conditions relevant to cardiovascular medicine: valvular heart disease, peripheral vascular disease, pulmonary embolism, and cardiogenic shock. The landmark randomised SYNTAX trial introduced the concept of the HT in decision-making between coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) in complex coronary artery disease (CAD). This was done to overcome the historical practice of the cardiologist acting as a gatekeeper to revascularisation, with the consequence of patients potentially being denied guideline-directed revascularisation therapy (CABG or PCI) through inappropriate use or underuse12. It is notable that since the publication of the SYNTAX trial both European and US guidelines on myocardial revascularisation have given a Class IC recommendation for HT decision-making between CABG and PCI34.

The anatomical SYNTAX score (aSS) was developed prior to the design of the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trial...