Since the publication of the original SYNTAX trial, there have been great technical advancements that have influenced the results of angioplasty:

• New tools for risk stratification using the SYNTAX II score which integrate clinical and anatomical variables to the team’s decision-making process.
• Functional revascularization (hybrid use of fractional flow reserve or instantaneous wave-free ratio).
• Optimization of stenting through intravascular ultrasound.
• Contemporary techniques for the rechanneling of total occlusions.
• Clinical therapies according to guidelines.
• New thin-strut bioresorbable-polymer everolimus-eluting stents.

This was a single-arm study in patients with multivessel disease on the impact of these new technologies on 450 patients who were compared with the original SYNTAX cohort and were selected based on similar mortality rates at 4 years. The study also carried out an exploratory comparison of this cohort and the historical cohort that underwent surgery.

At 2 years, the 454 patients in the SINTAX II cohort experienced significantly less events than the historical cohort (major adverse cardiac or cerebrovascular events [MACCE]: 10.7% for SYNTAX II patients vs. 17.4% for SYNTAX patients; hazard ratio [HR]: 0.59; 95% confidence interval [CI]: 0.40-0.86; p = 0.007). Such difference was driven by lower rates of both infarction (HR: 0.27; 95% CI: 0.11-0.70; p = 0.007) and revascularization (HR: 0.57; 95% CI: 0.37-0.89; p = 0.014).

Read also: EuroPCR 2018 | Compare-Acute: FFR or Primary Angioplasty at a 2-Year Follow-Up After Complete Revascularization.

The rates of mortality and stroke were similar. The rates of definite stent thrombosis were significantly lower with the new strategy (HR: 0.26; 95% CI: 0.07-0.97; p = 0.045).

The exploratory comparison with myocardial revascularization surgery suggests equivalent results for the SYNTAX II strategy in patients with a >22 score, not only in patients with low anatomical risk.

Original title: SYNTAX II: Two-Year Clinical Outcomes of the Study Using State-of-the-Art Percutaneous Coronary Revascularisation in Patients with De Novo Three-Vessel Disease.

Presenter:  Patrick W. Serruys.

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