Contemporary and evolving risk scoring algorithms for percutaneous coronary intervention

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.