Usefulness of SYNTAX score II in complex percutaneous coronary interventions in the setting of acute coronary syndrome

The anatomical synergy between percutaneouscoronary intervention (PCI) with taxus andcardiac surgery (SYNTAX) score (SS) is advocatedin both European and American revascularizationguidelines [1,2] as an important tool that can helpclinicians to establish the optimal revascularizationapproach in patients with complex coronaryartery disease (CAD). The model has also beenproposed as a predictor of clinical outcome followingPCI [3]. However, it is well recognized thatboth anatomical and clinical variables arerequired to appropriately stratify the risk ofpatients undergoing PCI. Therefore, recent scoreshave been developed with the aim of integratinganatomical features with relevant clinical variables,to overcome the most obvious pitfalls of asystem score only based on coronary angiograms[4,5]. Recently, seven clinical parameters [age, creatinineclearance, left ventricular ejection fraction(LVEF), presence of unprotected left main (ULM),peripheral vascular disease, female sex, andchronic obstructive pulmonary disease] have beenadded to SS to obtain SYNTAX score II (SS II) [4].This new score is able to predict a statistically significantdifference in long-term outcomes betweenpatients undergoing coronary artery bypass graft(CABG) and those undergoing PCI [5,6].However, SS II has been only validated in randomizedtrials, not in a real-world study; thus,excluding complex patients such as those withthree-vessel disease and/or ULM involvement,particularly in the setting of acute coronary syndromes(ACS).The aim of the current study was to evaluate theusefulness of SS II in a real-world population withsevere CAD and ACS undergoing PCI.