Banning AP, Serruys P, De Maria GL, et al. - Improved and durable clinical outcomes were achieved with employment of the SYNTAX II percutaneous coronary intervention (PCI) strategy in patients with de novo three-vessel disease, relative to predefined patients treated with PCI in the original SYNTAX I trial. In a predefined exploratory analysis, major adverse cardiac and cerebrovascular events (MACCE) did not differ significantly between SYNTAX II PCI and matched SYNTAX I coronary artery bypass grafting (CABG) patients at 5-year follow-up.

• A multicenter, single-arm, open-label study, SYNTAX II, was conducted with patients needing revascularization who showed clinical equipoise for management with either CABG or PCI, predicted by the SYNTAX score II.

• A matched PCI cohort trial and a matched CABG cohort, both from the SYNTAX I trial, served as comparators.

• A significantly lower MACCE rate at 5 years was found in SYNTAX II vs in the SYNTAX I PCI cohort (21.5% vs 36.4%).

• This reflected lower rates of revascularization (13.8% vs 23.8%), and myocardial infarction (MI) (2.7% vs 10.4%), including both procedural MI (0.2% vs 3.8%) and spontaneous MI (2.3% vs 6.9%).

• SYNTAX II demonstrated lower all-cause death (8.1% vs 13.8%) indicating a lower rate of cardiac death (2.8% vs 8.4%).

• At 5 years, similar major adverse cardiac and cerebrovascular events’ outcomes were found among patients in SYNTAX II and predefined patients in the SYNTAX I CABG cohort.