title: Predictive Performance of SYNTAX Score II in Patients With Left Main and Multivessel Coronary Artery Disease-analysis of CREDO-Kyoto registry.
abstract: BACKGROUND
  SYNTAX score II (SSII) provides individualized estimates of 4-year mortality after coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in order to facilitate decision-making between these revascularization methods. The purpose of the present study was to assess SSII in a real-world multicenter registry with distinct regional and epidemiological characteristics.
  
  
  RESULTS
  Long-term mortality was analyzed in 3,896 patients undergoing PCI (n=2,190) or CABG (n=1,796) from the Coronary REvascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) PCI/CABG registry cohort-2. SSII discriminated well in both CABG and PCI patient groups (concordance index [c-index], 0.70; 95% CI: 0.68-0.72; and 0.75, 95% CI: 0.72-0.78) surpassing anatomical SYNTAX score (SS; c-index, 0.50; 95% CI: 0.47-0.53; and 0.59, 95% CI: 0.57-0.61). SSII had the best discriminative ability to separate low-, medium- and high-risk tertiles, and calibration plots showed good predictive performance for CABG and PCI groups. Use of anatomical SS as a reference improved the overall reclassification provided by SSII, with a net reclassification index of 0.5 (P<0.01).
  
  
  CONCLUSIONS
  SSII has robust prognostic accuracy, both in CABG and in PCI patient groups and, compared with the anatomical SS alone, was more accurate in stratifying patients for late mortality in a real-world complex coronary artery disease Eastern population.
authors.affiliation: Department of Interventional Cardiology, Erasmus Medical Centre-University Medical Centre Rotterdam.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Campos
authors.forename: David
authors.initials: D
authors.lastname: van Klaveren
authors.forename: Javaid
authors.initials: J
authors.lastname: Iqbal
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Onuma
authors.forename: Yao-Jun
authors.initials: YJ
authors.lastname: Zhang
authors.forename: Hector M
authors.initials: HM
authors.lastname: Garcia-Garcia
authors.forename: Marie-Angele
authors.initials: MA
authors.lastname: Morel
authors.forename: Vasim
authors.initials: V
authors.lastname: Farooq
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shiomi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Furukawa
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakagawa
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kadota
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Lemos
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality*; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D011237:Predictive Value of Tests; D012042:Registries; D013997:Time Factors