Validity of SYNTAX score II for risk stratification of percutaneous coronary interventions: A patient-level pooled analysis of 5433 patients enrolled in contemporary coronary stent trials Carlos M. Campos a,b , Hector M. Garcia-Garcia a,c, ⁎, David van Klaveren d , Yuki Ishibashi a , Yun-Kyeong Cho a , Marco Valgimigli a , Lorenz Räber e , Hans Jonker c , Yoshinobu Onuma a , Vasim Farooq a , Scot Garg f , Stephan Windecker e , Marie-Angele Morel c , Ewout W. Steyerberg d , Patrick W. Serruys a,g a Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands b Department of Interventional Cardiology Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil c Cardialysis, Rotterdam, The Netherlands d Department of Public Health, Erasmus MC — University Medical Centre Rotterdam, Rotterdam, The Netherlands e Department of Cardiology, Bern University Hospital, Bern, Switzerland f Department of Cardiology, East Lancashire Hospitals NHS Trust, Blackburn, United Kingdom g International Centre for Circulatory Health, NHLI, Imperial College London, London, United Kingdom abstract article info Article history: Received 8 October 2014 Received in revised form 2 March 2015 Accepted 17 March 2015 Available online 18 March 2015 Keywords: SYNTAX score SYNTAX score II Percutaneous coronary intervention Drug-eluting stent Risk stratification Objectives: To assess the clinical profile and long-term mortality in SYNTAX score II based strata of patients who received percutaneous coronary interventions (PCI) in contemporary randomized trials. Background: The SYNTAX score II was developed in the randomized, all-comers' SYNTAX trial population and is composed by 2 anatomical and 6 clinical variables. The interaction of these variables with the treatment provides individual long-term mortality predictions if a patient undergoes coronary artery bypass grafting (CABG) or PCI. Methods: Patient-level (n = 5433) data from 7 contemporary coronary drug-eluting stent (DES) trials were pooled. The mortality for CABG or PCI was estimated for every patient. The difference in mortality estimates for these two revascularization strategies was used to divide the patients into three groups of theoretical treat- ment recommendations: PCI, CABG or PCI/CABG (the latter means equipoise between CABG and PCI for long term mortality). Results: The three groups had marked differences in their baseline characteristics. According to the predicted risk differences, 5115 patients could be treated either by PCI or CABG, 271 should be treated only by PCI and, rarely, CABG (n = 47) was recommended. At 3-year follow-up, according to the SYNTAX score II recommendations, patients recommended for CABG had higher mortality compared to the PCI and PCI/CABG groups (17.4%; 6.1% and 5.3%, respectively; P b 0.01). Conclusions: The SYNTAX score II demonstrated capability to help in stratifying PCI procedures. © 2015 Elsevier Ireland Ltd. All rights reserved. 1. Introduction The SYNTAX score [1–3] was developed for the randomized com- parison of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in the Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) trial [2]. The SYNTAX score provides objective quantification on the diseased coronary artery segment in terms of its severity, anatomical location and importance in supplying blood to the myocardium. Based on the results of the SYNTAX trial [2,4,5] the SYNTAX score has been implemented as a wa- tershed between CABG and PCI in prevailing guidelines [6,7]. However, the SYNTAX score cannot account for the effect related to clinical factors which are widely acknowledged to impact on long-term outcomes, such as a patients' age, left ventricular ejection fraction, and renal function [8–10]. Recently, the SYNTAX score II was developed by applying a Cox pro- portional hazards model to the SYNTAX trial data. A combination of clin- ical and anatomical predictors [5,11], together with their interaction with the treatment modality (CABG or PCI), enables estimation of the absolute risk difference between CABG and PCI and has the potential to assist the multidisciplinary decision-making process between these International Journal of Cardiology 187 (2015) 111–115 ⁎ Corresponding author at: Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands. E-mail addresses: h.garciagarcia@erasmusmc.nl, hect2701@gmail.com (H.M. Garcia-Garcia). http://dx.doi.org/10.1016/j.ijcard.2015.03.248 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved. Contents lists available at ScienceDirect International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard