title: Usefulness of SYNTAX score II in complex percutaneous coronary interventions in the setting of acute coronary syndrome.
abstract: BACKGROUND
  SYNTAX score II (SS II) integrates anatomical SS with clinical characteristics allowing an individualized prediction of long-term mortality.
  
  
  OBJECTIVE
  We sought to assess to evaluate the usefulness of SS II in a real-world acute coronary syndromes (ACS) population with severe coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI).
  
  
  METHODS
  From August 2011 to May 2013, out of 1591 consecutive patients admitted for ACS, 217 (13.6%) showed severe CAD (three-vessel disease and/or left main involvement). Among the latter, 100 patients underwent PCI and were enrolled into the study. SS II was calculated in all patients. One-year clinical follow-up was performed; major adverse cardiac and cerebrovascular events (MACCE) were defined as a composite of death, nonfatal myocardial infarction, stroke, or repeat revascularization.
  
  
  RESULTS
  The median SS II was 29 (range, 14-59). Overall, MACCE occurred in 25% of patients (cardiac death 4%, myocardial infarction 4%, stroke 0%, and repeat revascularization 17%). The 1-year MACCE-free survival was significantly lower in patients with SS (⩾29), than in those with SS II (<29) (64.2% vs. 87.2%, respectively; p = 0.007). In multivariate Cox regression analysis, the presence of unprotected left main stenosis [hazard ratio 2.52, 95% confidence interval (CI): 1.02-5.85; p = 0.031] and SS II ⩾29 (hazard ratio 2.74, 95% CI: 1.30-8.21; p = 0.011) were the only predictors of MACCE at 1-year clinical follow-up. The c-index of SS score II was 0.70 (95% CI: 0.58-0.81). For patients who experienced MACCE, the SS II reclassification improved by 36%, while in nonevent patients the reclassification improved by 22%. The net reclassification index was 0.24 (p = 0.09).
  
  
  CONCLUSIONS
  SS II might represent a useful tool to predict clinical events in not only ideal stable patients, but also an unrestricted, real world population of patients with ACS and severe CAD undergoing PCI.
authors.affiliation: Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy.
authors.forename: Azzarelli
authors.initials: A
authors.lastname: Salvatore
authors.affiliation: Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy; Faculty of Medicine of Tunis,University of Tunis El Manar, Tunisia.
authors.forename: Marouane
authors.initials: M
authors.lastname: Boukhris
authors.affiliation: Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Giubilato
authors.affiliation: Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy.
authors.forename: Salvatore Davide
authors.initials: SD
authors.lastname: Tomasello
authors.affiliation: Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy.
authors.forename: Marine
authors.initials: M
authors.lastname: Castaing
authors.affiliation: Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Giunta
authors.affiliation: Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Marzà
authors.affiliation: Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy; Maadi Military Hospital, Military Medical Academy, Cairo, Egypt.
authors.forename: Hosam Mohamad
authors.initials: HM
authors.lastname: Abdelbasset
authors.affiliation: Cardiology Unit, University Egypt, Cairo, Egypt.
authors.forename: Hazem
authors.initials: H
authors.lastname: Khamis
authors.affiliation: Department of Clinical and Experimental Medicine, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy.
authors.forename: Alfredo Ruggero
authors.initials: AR
authors.lastname: Galassi
keywords: Acute coronary syndrome; Percutaneous coronary intervention; Severe coronary artery disease; Syntax score II