title: Risk stratification in 3-vessel coronary artery disease: Applying the SYNTAX Score II in the Heart Team Discussion of the SYNTAX II trial.
abstract: BACKGROUND
  Heart Team (HT) and the SYNTAX Score II (SSII) have been integrated to the contemporary guidelines with the aim to provide a multidisciplinary decision-making process between coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI).
  
  
  OBJECTIVE
  To prospectively assess the agreement between the HT decision and the SSII recommendation regarding the revascularization strategy in patients with 3-vessel coronary artery disease (CAD) of the SYNTAX II trial.
  
  
  METHODS
  The SSII predicts the 4-year mortality of an individual patient both after PCI and after CABG. Patients were treated by PCI when the SSII predicted a mortality risk favoring PCI or when risk predictions were equipoise between PCI and CABG. However, the HT could overrule the SSII and recommend either CABG or PCI.
  
  
  RESULTS
  A total of 202 patients have been screened and 24 did not fulfill inclusion criteria. The median age was 67.0 (IQR 59.0-73.3), and 167 (82.7%) were male. The HT endorsed SSII treatment recommendation, for CABG or PCI, in 152 patients (85.4%). Three patients had preference for PCI, irrespective of the HT decision. The main reason for the HT to overrule the SSII and recommend CABG was the prospect of a more complete revascularization (21 of 25 patients). Patients recommended for CABG by the HT had significantly higher anatomical SYNTAX score (P = 0.03) and higher predicted mortality risk for PCI (P = 0.04) when compared with patients that were enrolled in the trial.
  
  
  CONCLUSIONS
  The SYNTAX score II showed to be a suitable tool for guiding treatment decisions of patients with 3-vessel coronary artery disease being endorsed by the HT in the vast majority of the patients that have been enrolled in the SYNTAX II trial.
authors.affiliation: Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands.|Department of Interventional Cardiology, Heart Institute, Medical School, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Campos
authors.affiliation: Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands.|Department of Interventonal Cardiology, University Hospital Clinical Centre Banja Luka, Banja Luka, Bosnia and Herzegovina.
authors.forename: Bojan M
authors.initials: BM
authors.lastname: Stanetic
authors.affiliation: Department of Intervenional Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, United Kingdom.
authors.forename: Vasim
authors.initials: V
authors.lastname: Farooq
authors.affiliation: Belfast Health & Social Care Trust, Belfast, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Walsh
authors.affiliation: Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Ishibashi
authors.affiliation: Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Onuma
authors.affiliation: Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Hector M
authors.initials: HM
authors.lastname: Garcia-Garcia
authors.affiliation: Cardiovascular Institute, Hospital Clinico San Carlos and Centro Nacional De Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Escaned
authors.affiliation: Department of Interventional Cardiology, Oxford University Hospitals, Oxford, United Kingdom.
authors.forename: Adrian
authors.initials: A
authors.lastname: Banning
authors.affiliation: International Centre for Circulatory Health, NHLI, Imperial College London, London, United Kingdom.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000453:epidemiology / Q000473:pathology; D003657:Decision Making; D003658:Decision Making, Computer-Assisted; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016037:Single-Blind Method; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: coronary artery disease; drug eluting; risk stratification; stent