10
Evaluation
Defining Lesion Severity
Defining Coronary Artery Lesion Complexity: Calculation of
the SYNTAX Score
COR LOE
Recommendation
2b B-NR 1. In patients with multivessel CAD, an assessment of CAD
complexity, such as the SYNTAX score, may be useful to guide
revascularization.
Table 4. Angiographic Features Contributing to Increasing
Complexity of CAD
• Multivessel disease
• Left main or proximal LAD artery lesion
• Chronic total occlusion
• Trifurcation lesion
• Complex bifurcation lesion
• Heavy calcification
• Severe tortuosity
• Aorto-ostial stenosis
• Diffusely diseased and narrowed segments distal to the lesion
• Thrombotic lesion
• Lesion length >20 mm
Use of Coronary Physiology to Guide Revascularization With
PCI
COR LOE
Recommendations
1 A 1. In patients with angina or an anginal equivalent,
undocumented ischemia, and angiographically intermediate
stenoses, the use of FFR or iFR is recommended to guide the
decision to proceed with PCI.
3: No
benefit
B-R 2. In stable patients with angiographically intermediate stenoses
and FFR >0.80 or iFR >0.89, PCI should NOT be performed.
Intravascular Ultrasound to Assess Lesion Severity
COR LOE
Recommendation
2a B-NR 1. In patients with intermediate stenosis of the left main artery,
IVUS is reasonable to help define lesion severity.
