SYNTAX Score II: Combines anatomical SYNTAX score with clinical variables to predict 4-year mortality and guide PCI vs. CABG decisions.
Anatomical & Age
Clinical Comorbidities
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Patients with complex multi-vessel coronary artery disease (CAD) or left main disease being evaluated for revascularization.
To assist the "Heart Team" in deciding between Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Grafting (CABG).
To predict 4-year all-cause mortality for both interventional strategies.
Section 2
Formula & Logic
Beyond Anatomy
The original SYNTAX score is purely anatomical and often favors CABG in complex disease. However, for many patients (e.g., elderly, those with COPD), the surgical risk outweighs the anatomical benefit. SYNTAX Score II integrates 8 predictors to provide a more personalized risk assessment.
Model Predictors
01
Anatomical SYNTAX Score: Base anatomical complexity.
02
Age: Older age favors PCI (reduced surgical tolerance).
Left Ventricular Ejection Fraction (LVEF): Lower EF increases surgical risk.
05
Unprotected Left Main Disease: Clinical status of LMT.
06
Peripheral Vascular Disease (PVD): Associated with poor surgical/interventional outcomes.
07
COPD: Strong predictor of high surgical morbidity.
08
Female Sex: Associated with smaller vessels and different CABG/PCI outcomes.
Section 3
Pearls/Pitfalls
PCI vs. CABG: The Equipoise Zone
The algorithm identifies a "Treatment Equipoise" zone where predicted 4-year mortality is similar between PCI and CABG. In these cases, patient preference and local procedural expertise should drive the decision.
ESC/EACTS Guidelines
The 2018 ESC Guidelines on Myocardial Revascularization endorse the use of SYNTAX Score II (Class IIa) for complex CAD decision-making.
Section 4
Evidence Appraisal
Development & Validation
Anatomical and clinical SYNTAX score II to individualize the decision-making between percutaneous and surgical revascularization.
Farooq V et al. • Lancet.. 2013;381(9873):1239-50. Derived from the randomized SYNTAX trial (n=1,800) and validated in the DELTA registry.
