The SYNTAX score on its way out or … towards artificial intelligence. Part I


5 November Nov 2019 5 months ago
  • Andreini D, Pompilio G, Bartorelli A

Recent publications on the SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) score have caught the general attention and triggered this written reaction on the history and evolution of the SYNTAX score over the last decades.

The evolution of the risk score algorithms derived from the historical SYNTAX I trial led to SYNTAX III Revolution trial that, for the first time, randomised two Heart Teams to use either the SYNTAX score II (anatomy plus comorbidities) derived from a conventional cineangiography or a SYNTAX score III (anatomy, plus functional significance, plus comorbidities) derived from a multislice computed tomography (MSCT), providing the Heart Team with a fractional flow reserve (FFR) for the assessment of the functional impact of the stenotic lesions.

The next historic milestone will be the use of machine learning and artificial intelligence to provide the practitioner with a non-invasive, automatic, objective and reproducible analysis of the anatomic and functional SYNTAX score derived from MSCT, that will be automatically combined with the collected comorbidities of the patient in order to provide clinicians with a SYNTAX score III, a predictive assessment of late all-cause mortality, in case of either surgical or percutaneous treatment, based on anatomy, comorbidities and functionality.

This paper (first author Patrick Serruys), before describing these future options, reviews the historical foundation, the evolution and peripeteia of the score over the last decades.

1. Serruys PW, Chichareon P, Modolo R, Leaman DM, Reiber JHC, Emanuelsson H, Di Mario C, Pijls NHJ, Morel MA, Valgimigli M, Farooq V, van Klaveren D, Capodanno D, Andreini D, Bourantas CV, Davies J, Banning AP, Escaned J, Piek JJ, Echavarría-Pinto M, Taylor CA, Thomsen B, Collet C, Pompilio G, Bartorelli AL, Glocker B, Dressler O, Stone GW, Onuma Y. The SYNTAX score on its way out or … towards artificial intelligence: part I. EuroIntervention 2019 Oct 25. pii: EIJ-D-19-00543A. doi: 10.4244/EIJ-D-19-00543A. Go to PubMed