title: Individual Long-Term Mortality Prediction Following Either Coronary Stenting or Bypass Surgery in Patients With Multivessel and/or Unprotected Left Main Disease: An External Validation of the SYNTAX Score II Model in the 1,480 Patients of the BEST and PRECOMBAT Randomized Controlled Trials.
abstract: The study sought to validate the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score II mortality prediction model after percutaneous coronary intervention (PCI) or coronary artery bypass grafting in a large pooled population of patients with multivessel coronary disease (MVD) and/or unprotected left main disease (UPLMD) enrolled in the PRECOMBAT (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease) and BEST (Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease) randomized controlled trials.
  
  
  
  For patients with MVD and/or UPLMD, the choice of the best revascularization strategy remains challenging.
  
  
  
  Pooled individual patient-level data from PRECOMBAT and BEST were used to assess calibration and discrimination of the SYNTAX score II prediction model for all-cause mortality after PCI and coronary artery bypass grafting at 4-year follow-up. The study population comprised 1,480 patients (600 with UPLMD, 880 with MVD).
  
  
  
  The overall incidence of all-cause mortality was 6.1% after a median follow-up period of 4.9 years. Validation plots showed good model calibration overall and across treatment groups but tended to overestimate all-cause mortality in the highest risk quintiles of patients in the whole population and the PCI arm. The SYNTAX score II showed moderate discrimination ability for the whole population (C index = 0.685) but better for patients receiving PCI than CABG (C index = 0.718 vs. 0.662 in patients with UPLMD, C index = 0.700 vs. 0.661 in those with MVD). Observed all-cause mortality was higher when the treatment received was at variance with that recommended by the model and similar when it was concordant.
  
  
  
  The SYNTAX score II has good calibration but only moderate discrimination ability for long-term mortality prediction in this randomized population. This score provides an important tool to help guide the heart team's decision-making process regarding the selection of the best revascularization strategy for patients with MVD and/or UPLMD. (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease, NCT00422968; Bypass Surgery Versus Everolimus-Eluting Stent Implantation for Multivessel Coronary Artery Disease, NCT00997828).
authors: Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors: Yohei
authors: Y
authors: Sotomi
authors: ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors: Rafael
authors: R
authors: Cavalcante
authors: Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
authors: David
authors: D
authors: van Klaveren
authors: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors: Jung-Min
authors: JM
authors: Ahn
authors: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors: Cheol Whan
authors: CW
authors: Lee
authors: Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors: Robbert J
authors: RJ
authors: de Winter
authors: Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors: Joanna J
authors: JJ
authors: Wykrzykowska
authors: ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors: Yoshinobu
authors: Y
authors: Onuma
authors: Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
authors: Ewout W
authors: EW
authors: Steyerberg
authors: Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors: Seung-Jung
authors: SJ
authors: Park
authors: International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom. Electronic address: patrick.w.j.c.serruys@gmail.com.
authors: Patrick W
authors: PW
authors: Serruys
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: SYNTAX Score II; coronary artery disease; external validation; multivessel disease; randomized control trial; unprotected left main disease