title: Validation and comparison of the long-term prognostic capability of the SYNTAX score-II among 1,528 consecutive patients who underwent left main percutaneous coronary intervention.
abstract: OBJECTIVE
  This study sought to evaluate the long-term prognostic capacity of the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score II (SS-II) and compare it with other risk scores among patients undergoing left main percutaneous coronary intervention (LM-PCI).
  
  
  BACKGROUND
  Recently, the SS-II was developed in an attempt to individualize and help the decision-making process between PCI and coronary artery bypass graft (CABG) surgery in the management of complex coronary artery disease (CAD). However, there is a paucity of data regarding the utility of SS-II in patients undergoing LM-PCI.
  
  
  METHODS
  Data from 1,528 consecutive patients from a single center undergoing unprotected LM-PCI were prospectively collected. The SS-II and other scores were then derived using patients' baseline clinical characteristics. Patients were stratified according to tertiles of SS-II for PCI: SS-II ≤21 (n = 508), SS-II >21 and ≤28 (n = 480), and >28 (n = 540). Predictive capability for long-term mortality was compared between angiographic scores and scores combining both angiographic and clinical variables.
  
  
  RESULTS
  At a mean follow-up of 4.4 years, mortality in the first, second, and third SS-II tertiles was 1.8%, 3.5%, and 9.4%, respectively (p < 0.0001). Multivariate analysis showed SS-II to be a strong independent predictor of mortality (hazard ratio: 1.76, 95% confidence interval: 1.10 to 2.82; p = 0.02) after LM-PCI. When compared with the angiographic SS, scores combining both clinical and angiographic variables, such as the SS-II, were superior in terms of long-term prognostication.
  
  
  CONCLUSIONS
  Results of this large series of consecutive patients who underwent unprotected LM-PCI suggested that the SS-II has better long-term prognostic power in terms of mortality compared with the original purely angiographic SS.
authors.affiliation: Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Xu
authors.affiliation: Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York; Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada. Electronic address: pg2295@columbia.edu.
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
authors.affiliation: Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China.
authors.forename: Yuejin
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.affiliation: Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Xu
authors.affiliation: Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China.
authors.forename: Shubin
authors.initials: S
authors.lastname: Qiao
authors.affiliation: Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China.
authors.forename: Yongjian
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China.
authors.forename: Hongbing
authors.initials: H
authors.lastname: Yan
authors.affiliation: Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China.
authors.forename: Jilin
authors.initials: J
authors.lastname: Chen
authors.affiliation: Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China.
authors.forename: Yelin
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China.
authors.forename: Yanyan
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Istituto di Cardiologia, University of Bologna, Bologna, Italy.
authors.forename: Tullio
authors.initials: T
authors.lastname: Palmerini
authors.affiliation: Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.affiliation: Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China. Electronic address: gaorunlin@citmd.com.
authors.forename: Runlin
authors.initials: R
authors.lastname: Gao
mesh_terms: D000328:Adult; D000368:Aged; D002681:China; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: SYNTAX score; SYNTAX score II; coronary artery bypass grafting; left main; percutaneous coronary intervention