Syntax score calculation

simulation
Sistem skoring

Yoon YH, et al.JACC Cardiovasc Interv 2020; 13: 361–371.

Takahashi K,et al.Lancet 2020; 396: 1399–1412.
SYNTAX (The Synergy between PCI with Taxus and Cardiac Surgery)

Penilaian kompleksitas anatomi koroner

Terutama pada LMCA dan three vessel disease

Membandingkan IKP dengan 1st DES (paclitaxel)

vs. BPAK

Neumann FJ, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2019; 40: 87–165.
SYNTAX score (Low score ≤ 22, intermediate score 23-32 dan high score ≥ 33)

Neumann FJ, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2019; 40: 87–165.
Stenoses more
than three
vessel reference
diameters apart
are
considered as
separate lesions
Trifurcation scoring Bifurcation scoring
Segments : • 5/6/11
• 3/4/16/16a, • 6/7/9
• 5/6/11/12 • 7/8/10
• 11/12a/12b/13 • 11/13/12a
• 6/7/9/9a • 13/14/14a
• 7/8/10/10a should be • 3/4/16
considered for • 13/14/15
Tortuosity
(≥1 bends of
≥90°, or ≥3
or more
bends of 45°
to 90°
proximal to
the diseased
segment
Sistem skoring

Yoon YH, et al.JACC Cardiovasc Interv 2020; 13: 361–371.

Takahashi K,et al.Lancet 2020; 396: 1399–1412.
SYNTAX score 2020
(Prediksi kematian 10 tahun, macCe 5 tahun)

Takahashi K,et al. Lancet 2020; 396: 1399–1412.

 Case List
1. CAD 3VD, LM disease, CTO di RCA dan
LAD
2. CAD 3VD
3. CAD 3VD, triple CTO
4. CAD 2VD, LM disease
 Case 1-
CAD 3VD, LM disease, CTO di
RCA dan LAD
 CHF FC NYHA II ec CAD 3VD, LM
disease, CTO di RCA dan LAD

Male, 48 MR moderate AR mild TR mild

y.o, 92
HHD
kg-169
cm, ex- Dislipidemia
smoker
CrCl 66
AoD 30 mm
LAd 39 mm

LVIDd 53.3 mm
LVMI 479 g/m2
RWT 0.7
EF 37% teichz
KESIMPULAN
•Dilatasi LV, RV, LVH Ekesentrik

•RWMA(+) luas

•Fungsi sistolik LV turun LVEF 35.3% (biplane), GLS:-5.7%

•Disfungsi Diastolik Grade III

•Fungsi sistolik RV normal

•MR Moderate

•AR Mild TR Mild

 Case 2-
CAD 3VD
 APS CCS II ec CAD 3VD

Male, 51
y.o, 68 HHD
kg-170
cm, ex- Dislipidemia
smoker
CrCl: 89
 ANAMNESIS
Pasien dengan nyeri dada tipikal angina.
DOE (+), PND(-), OP (-). Kaki bengkak (-)

Faktor risiko CAD :

HT (+), DM (-), Dislipidemia(+), ex smoker (+) berhenti 2 tahun, FH (-)

Riw pengobatan :
Miniaspi 80 mg/24 jam
Candesartan 16 mg/24 jam
Carvedilol 12.5 mg/12 jam
Simvastatin 20 mg/24 jam
Nitrokaf R 2.5 mg/12 jam
ISDN 5 mg (bila perlu)
 Ao 28 mm
LA 32 mm

LVIDd 39 mm
LVMI 142 g/m2
RWT 0.4
EF 57.5% teichz
KESIMPULAN

•Dimensi jantung dalam batas normal, LVH eksentrik

•RWMA(+)

•Fungsi sistolik LV baik dengan LVEF 58.2% (biplane), GLS

-12.6%

•Fungsi sistolik RV baik

• MR mild, TR mild
Syntax score
 Case 3-
CAD 3VD, triple CTO
 APS CCS II ec CAD 3VD,
triple CTO
Male, 59
y.o, 75 HHD
kg-162
cm, ex- Dislipidemia
smoker
CrCl: 17
 ANAMNESIS
Nyeri dada terutama jika berktivitas berat, membaik dengan istitrahat

DOE(+) PND(-) OP(-) Riwayat kaki bengkak(-)

Faktor risiko CAD :

•HT (+), DM (-), Dislipidemia (+), ex smoker (+), Family history (-)

Riw pengobatan :
• Miniaspi 80 mg/24 jam
• Perindopril 10 mg/24 jam
• Bisoprolol 5 mg/24 jam
• Atorvastatin 20 mg/24 jam
• Amlodipin 5 mg/24 jam
• Furosemide 20 mg/24 jam
• Spironolakton 25 mg/24 jam
• Nitrokaf retard 2.5 mg/12 jam
• Lansoprazol 30 mg/24 jam
 Ao 36mm
LA 36mm

LVIDd 59.9mm
LVMI 156 g/m2
RWT 0.4
EF 47.8% teichz
KESIMPULAN:
• Dilatasi LV, LVH Eksentrik

• RWMA(+)

• Fungsi sistolik LV turun, LVEF 44.8 % (biplane), GLS -6.4%

• Disfungsi diastolik LV Grade I

• Fungsi sistolik RV turun

• Mild MR
Syntax score?
Nuclear Viability Study
 Case 4-
CAD 2VD, LM disease
 APS CCS II ec CAD 2VD, LM
disease

Male, 57 HHD
y.o, ex-
smoker
CrCl: 78
 ANAMNESIS
Nyeri dada (+) sejak Oktober 2020: hilang timbul, terasa seperti ditekan
beban berat, muncul bila beraktivitas dan berkurang dengan istirahat,
terkadang tembus ke punggung, tidak disertai keringat dingin..
Sesak (-), berdebar-debar (-), pingsan (-), kaki bengkak (-).

Faktor risiko CAD :

DM (-), Hipertensi (+), DL (-), ex smoker (+), FH (-)

Riw pengobatan :
Miniaspi 80 mg/24 jam
Clopidogrel 75 mg/24 jam
Bisoprolol 2.5 mg/24 jam
Atorvastatin 20 mg/24 jam
Nitrokaf Retard 2.5 mg/12 jam
Diltiazem 15 mg/8 jam
HCT 25 mg/24 jam
LVIDd 55.7mm
LVMI 113 g/m2
RWT 0.4
EF 54.2% teichz
KESIMPULAN
• Dilatasi LA

• LVH konsentrik

• RWMA(+)

• Fungsi sistolik LV baik dengan LVEF 66.1%(biplane)

• Fungsi diastolik LV baik

• Fungsi sistolik RV baik

• Katup-katup baik
Syntax score?