• Scot Garg, Patrick W Serruys, Sigmund Silber, Joanna Wykrzykowska, Robert Jan van Geuns, Gert Richardt, Pawel E Buszman, Henning Kelbæk, Adrianus Johannes van Boven, Sjoerd H Hofma, Axel Linke, Volker Klauss, William Wijns, Carlos Macaya, Philippe Garot, Carlo DiMario, Ganesh Manoharan, Ran Kornowski, Thomas Ischinger, Antonio Bartorelli, Eric Van Remortel, Jacintha Ronden, and Stephan Windecker.
• Department of Interventional Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.
• JACC Cardiovasc Interv. 2011 Apr 1; 4 (4): 432-41.

ObjectivesThis study assessed the ability of the SYNTAX score (SXscore) to stratify risk in patients treated with percutaneous coronary intervention (PCI) using zotarolimus-eluting or everolimus-eluting stents.BackgroundThe SXscore can identify patients treated with PCI who are at highest risk of adverse events.MethodsThe SXscore was calculated prospectively in 2,033 of the 2,292 patients enrolled in the RESOLUTE All Comers study (RESOLUTE III All Comers Trial: A Randomized Comparison of a Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for Percutaneous Coronary Intervention). Clinical outcomes in terms of a patient-oriented composite endpoint (POCE) of all-cause death, myocardial infarction (MI), and repeat revascularization; the individual components of POCE; target lesion failure (TLF) (a composite of cardiac death, target-vessel MI, and clinically driven target lesion revascularization); and stent thrombosis were subsequently stratified according to SXscore tertiles: SXscore(LOW) ≤ 9 (n = 698), 9 17 (n = 659).ResultsAt 12-month follow-up, rates of POCE, MI, repeat revascularization, TLF, and the composite of death/MI were all significantly higher in patients in the highest SXscore tercile. Rates of stent thrombosis were all highest in the SXscore(HIGH) tertile (p > 0.05). After multivariate adjustment, the SXscore was identified as an independent predictor of POCE, MI, repeat revascularization, and TLF (p < 0.05 for all). At 12-month follow-up, the SXscore, ACEF score, and Clinical SXscore had C-statistics of 0.57, 0.78, and 0.67, respectively, for mortality and of 0.62, 0.56, 0.63, respectively, for POCE. No significant between-stent differences were observed for TLF or POCE in any of the SXscore tertiles.ConclusionsThe SYNTAX score is able to stratify risk amongst an all-comers population treated with PCI with second-generation drug-eluting stents (DES); however, improvements can be made with the inclusion of clinical variables. (RESOLUTE III All Comers Trial: A Randomized Comparison of a Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for Percutaneous Coronary Intervention; NCT00617084).Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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