Cerrato E, Barbero U, Quadri G, et al. - Whether the SYNTAX Score-II (SS-II) holds value as a tool to predict long-term death in patients who underwent left main PCI (LM-PCI) using second-generation drug-eluting stents, was investigated. In 804 patients in the FAILS-2 registry (failure in left main study with 2nd generation stents), researchers calculated SYNTAX score (SS) and the SS-II. Grouping of patients into following SS-II tertiles was done: low (SS-II ≤ 33; n = 278, 34.6%), intermediate (SS-II 34–43; n = 260, 32.3%) and high (SS-II ≥ 44; n = 266, 33.1%). All-cause mortality was assessed as the primary endpoint. Findings revealed the superiority of the SS-II to the SS with regard to the ability to predict outcomes related to contemporary LM-PCI. SS-II, along with Acute coronary syndrome (ACS) and Cardiogenic shock were identified as independent predictors of long-term death when multiple Cox regression analysis was used. ACS and T2DM are although not incorporated in the SS-II but served as additional markers of poor outcome in this real-world population.