• Lowering risk score profile during PCI in multiple vessel disease is associated with low adverse events: The ERACI risk score

    Abstract

    In recent years angiographic risk scores have been introduced in clinical practice to stratify different levels of risk after percutaneous coronary interventions (PCI). The SYNTAX score included all intermediate lesions in vessels ≥1.5 mm, consequently, multiple stent implantation was required.

    Four years ago, we built a new angiographic score in order to guide PCI strategy avoiding stent deployment both in intermediate stenosis as in small vessels, therefore these were not scored (ERACI risk score).

    The purpose of this mini review is to validate the strategy of PCI guided by this scoring, taking into account long term follow up outcomes of two observational and prospective registries where this policy was used. With this new risk score we have modified risk profile of our patient's candidates for PCI or coronary artery bypass surgery lowering the risk and <20% of them are now included anatomically as high risk for PCI. The simple exclusion of small vessels and intermediate stenosis from the revascularization approach resulted in clinical outcome comparable with the one of fractional flow reserve guided revascularization.

    Low events rate at late follow up observed in both studies was also in agreement with guided PCI by functional lesion assessment observed by Syntax II registry, where investigators found lower events rate in spite of a few number of stents implanted per patient.

    In conclusion: use of ERACI risk scores may significantly reclassify patients into a lower risk category and be associated with low adverse events rate.

    Highlights

     

    • Risk Scores have been introduced to predict outcome during PCI and they were built using angiographic variables but they included in the analysis intermediate lesions and small vessels.
    • The ERACI angiographic score analysing only angiographic variables but excluding in the scoring either intermediate lesions or lesions in small vessels was able to lowering risk score profile at baseline and after PCI.
    • After we applied ERACI score, <20% of patients with complex multiple vessel CAD are poor candidates for PCI (High Risk Score).
    • Prognosis value of ERACI score was validated by long term follow-up of two prospective studies, where penalty for not treated (nor stenting) those lesions not included in ERACI score was very low.
    • In summary, the use of ERACI risk scores may significantly reclassify patients into a lower risk category and PCI may become a viable option instead of CABG.

    Source:

    Cardiovascular Revascularization Medicine, 2018-10-01, Volume 19, Issue 7, Pages 792-794, Copyright © 2018 Elsevier Inc.

     

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