IMR Press / RCM / Volume 23 / Issue 4 / DOI: 10.31083/j.rcm2304133
Open Access Original Research
The Utility of the SYNTAX Score II and SYNTAX Score 2020 for Identifying Patients with Three-Vessel Disease Eligible for Percutaneous Coronary Intervention in the Multivessel TALENT Trial: A Prospective Pilot Experience
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1 Department of Cardiology, National University of Ireland, Galway (NUIG), H91 TK33 Galway, Ireland
2 Department of Cardiology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
3 Department of Cardiology, Royal Blackburn Hospital, BB2 3HH Blackburn, UK
4 Department of Cardiology, Wrightington, Wigan and Leigh NHS Foundation Trust, WN1 2NN Wigan, UK
5 Department of Cardiology, Royal Bournemouth Hospital, BH7 7DW Bournemouth, UK
6 Department of Cardiology, Freeman Hospital, NE7 7DN Newcastle, UK
7 Department of Interventional Cardiology, Clinique Pasteur, 31300 Toulouse, France
8 Department of Cardiology, Elisabeth-TweeSteden Ziekenhuis, 5042AD Tilburg, The Netherlands
9 Department of Cardiology, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands
10 Department of Cardiology, St. Johannes Hospital, 44137 Dortmund, Germany
11 Department of Cardiology, University Hospital Jean Minjoz, 25000 Besançon, France
12 Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
13 Department of Cardiology, Clinique Louis Pasteur, 54270 Nancy, France
14 Department of Cardiology, Heart Center, Segeberger Kliniken, 23795 Bad Segeberg, Germany
15 Department of Cardiology, University Hospital of Wales, CF14 4XW Cardiff, UK
16 Department of Cardiology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
17 Department of Cardiology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
18 Department of Cardiology, GCS ES-Axium-Rambot, 13090 Aix-en-Provence, France
*Correspondence: (Patrick W. Serruys)
These authors contributed equally.
Academic Editors: Peter A. McCullough and Federico Ronco
Rev. Cardiovasc. Med. 2022, 23(4), 133;
Submitted: 28 January 2022 | Revised: 10 March 2022 | Accepted: 21 March 2022 | Published: 8 April 2022
(This article belongs to the Special Issue Recent Advances in Percutaneous Coronary Intervention)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: Personalized prognosis plays a vital role in deciding between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with three-vessel disease (3VD). The aim of this study is to compare the modality of revascularization chosen by the local heart team to that recommended by using individualized predictions of medium, and long-term all-cause mortality amongst patients with 3VD screened in the Multivessel TALENT trial. Methods: The SYNTAX score II (SS-II) and SS-2020 were evaluated in 200 consecutive patients by a core laboratory and compared to the decision of the “on site” heart team. Results: According to the SS-II, CABG was the recommended treatment in 51 patients (25.5%) however 34 (66.6%) of them received PCI. According to SS-2020 the predicted absolute risk differences (ARD) between PCI and CABG were significantly higher in patients receiving CABG compared to those treated by PCI for major adverse cardiovascular and cerebrovascular events, a composite of all-cause mortality, stroke or myocardial infarction at 5-years (8.8 ± 4.6% vs 6.0 ± 4.0%, p < 0.001) and all-cause mortality at 5- (5.2 ± 3.5% vs 3.7 ± 3.0%, p = 0.008) and 10-years (9.3 ± 4.8% vs 6.2 ± 4.2%, p < 0.001). Based on the novel threshold of equipoise (individual absolute risk differences [ARD] <4.5%), 133 patients were eligible for PCI however 23 of them underwent CABG; conversely, amongst the 67 patients where CABG was recommendation (individual ARD >4.5%), only 19 received it. Conclusions: Despite the robustness of the risk models proposed for screening, several deviations from the recommended mode of revascularization were observed by the core laboratory among the first 200 patients with 3VD screened in the Multivessel TALENT trial. Clinical Trial Registration: reference: NCT04390672.

coronary artery bypass grafts (CABG)
percutaneous coronary intervention (PCI)
risk stratification
SYNTAX score
Fig. 1.
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