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

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.

SYNTAX Score-II Predicts Long-Term Mortality in Patients Who Underwent Left Main Percutaneous Coronary Intervention Treated With Second-Generation Drug-Eluting Stents

“…The current study shows that SS-II can independently predict the long-term mortality in patients treated with a second-generation DES, which provides further evidence to support the more routine use of SS-II in contemporary practice. However, in comparison with the study of Xu, et al, 5) the present study showed slightly higher long-term mortality (6.0% versus 5.0%) despite using second-generation DES which are supposed to have better clinical outcomes. The probable reasons for the difference include: 1) different numeric value of the SS-II.…”

“…SS-II was developed and internally validated in the SYNTAX trial 1,2) and externally validated in the DELTA 3) and CREDO-Kyoto registries, 4) but the above study populations included patients with LM and/or 3-vessel disease undergoing PCI, and the patients totally or mostly were treated with a first-generation DES. Although Xu, et al 5) reported that the SS-II was able to risk-stratify patients and predict long-term mortality in patients undergoing LM-PCI only, patients in their study were also mostly treated with a first-generation DES (62.3%), and only 33.5% of the patients underwent implantation with a second-generation DES (33.5%), and even a small number of bare metal stents (4.2%) were used. At present, second-generation DES are widely applied in patients with CAD undergoing PCI in clinical practice.…”

“…The probable reasons for the difference include: 1) different numeric value of the SS-II. The mean SS-II for PCI of the entire cohort in the Xu, et al study 5) was 25.6 ± 7.8, and the calculated SS-II Receiver operating characteristic curve analyses comparing the SS with the SS-II for the predictability of long-term mortality. The diagonal represents the line of no effect (AUC = 0.50), with curves above this line representing increasing diagnostic accuracy.…”

“…However, all previous studies [1][2][3][4][5] about the validation of the SS-II have enrolled patients totally or mostly treated with a first-generation DES and some even used a small number of bare metal stents. At present, second-generation DES are widely applied in patients with CAD undergoing PCI in clinical practice.…”

“…3,4) Therefore, the SS-II provides an impartial, evidence-based assessment of the decision-making process for clinicians weighing anatomical and clinical factors to establish the optimum revascularization technique for individual patients with complex CAD. However, all previous studies [1][2][3][4][5] about the validation of the SS-II have enrolled patients totally or mostly treated with a first-generation DES and some even used a small number of bare metal stents. At present, second-generation DES are widely applied in patients with CAD undergoing PCI in clinical practice.…”