6,963 publications from this institution
Risk stratification is an essential part of appropriately informing patients electing to undergo percutaneous coronary intervention (PCI). This process is also an integral part of the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery)-pioneered heart team approach in determining the most appropriate revascularisation modality for patients with complex coronary artery disease. The SYNTAX score was pioneered as an anatomical-based risk score to aid in this decision-making process; the lack of clinical variables in this score has, however, been its main limitation. This review examines the important established and evolving contemporary risk models used to aid this risk-stratification process. Risk scores based on clinical and anatomical variables alone and in combination—the latter of which is the subject of continuing research—are all explored. Other areas of discussion include risk scores based on the completeness of revascularisation and emerging concepts such as functional anatomical risk scores and the patient-empowered risk-benefit trade-off between PCI and coronary artery bypass grafting, to help personalise the choice of revascularisation modality.
The evolution of percutaneous coronary revascularization, after this treatment was introduced in clinical practice in the form of balloon angioplasty, has been characterized by three landmarks, corresponding to the development and application of an equal number of specific device types. In terms of chronologic appearance, these developments can be broadly categorized as bare metal stents, drug eluting stents (DES) and finally bioresorbable scaffolds (BRS). Bare metal stents were able to overcome some of the major drawbacks of balloon angioplasty, most importantly acute vessel closure and recoil, but their application was still plagued by significant rates of restenosis. The introduction of DES, and most importantly their further development in the second generation iterations, effectively managed the problem of restenosis and also reduced to clinically acceptable levels the incidence of an unexpected problem encountered during the long-term follow-up of the first generation DES, namely late stent thrombosis.
