SYNTAX Score II Predicts Mortality in 1- and 2-Vessel Disease

angiograph of coronary artery disease
angiograph of coronary artery disease
The SYNTAX score II was an independent predictor of mortality in patients with 1- and 2-vessel disease undergoing percutaneous coronary intervention.

The SYNTAX score II (SSII), which combines the original SYNTAX score with various clinical baseline variables associated with all-cause mortality, provided significant predictive value for long-term mortality in patients with 1- or 2-vessel disease undergoing a percutaneous coronary intervention (PCI) according to a study published in PLoS One.

The original anatomic SYNTAX score grades a patient’s coronary artery disease complexity in all coronary arteries and is commonly used to guide decision making among interventional cardiologists choosing between PCI and coronary artery bypass grafting.

Investigators of this study enrolled a total of 628 patients scheduled for a PCI as a result of either stable angina pectoris (43%) or acute coronary syndrome (57%). To calculate SSII, the investigators collected age, gender, creatinine clearance, left ventricular ejection fraction, peripheral vascular disease, and chronic obstructive pulmonary disease data at baseline. All-cause mortality comprised the primary end point.

Based on the SYNTAX score and baseline clinical variables, the SSII in this cohort ranged between 6.6 and 58.2 (median: 20.4, interquartile range 16.1-26.8). High SSII scores were more prevalent in patients who were older, had diabetes mellitus and hypertension, and had a history of renal insufficiency or heart failure. During a median follow-up of 4.5 years (interquartile range 3.4-4.9), all-cause mortality occurred in 44 patients (7.0%).

The SSII was a significant and independent predictor of all-cause mortality during follow-up in the multivariable Cox model (hazard ratio per point increase, 1.10; 95% CI, 1.07-1.13; P <.001). In addition, the SSII was deemed an independent predictor of the primary end point only in patients with stable angina pectoris (hazard ratio, 1.06; 95% CI, 1.07-1.11). For discrimination in this population, the concordance index of the SSII was 0.77 (95% CI, 0.69-0.84).

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A limitation of the analysis was the enrollment of patients from a single center, warranting subsequent multicenter analyses to validate the findings.

In addition to the SSII providing “value in patients with left main or 3-vessel disease, SSII may also offer accurate risk prediction in patients with less complex [coronary artery disease].”


Vroegindewey MM, Schuurman AS, Oemrawsingh RM, et al. SYNTAX score II predicts long-term mortality in patients with one- or two-vessel disease. PLoS One. 2018;13(7):e0200076.