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Prog Cardiovasc Dis. 2015 Nov-Dec;58(3):316-34. doi: 10.1016/j.pcad.2015.10.002. Epub 2015 Oct 31.

Bypass Grafting Versus Percutaneous Intervention-Which Is Better in Multivessel Coronary Disease: Lessons From SYNTAX and Beyond.

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Institute of Cardiovascular Sciences, Manchester Academic Health Sciences Centre, University of Manchester and Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, United Kingdom.
Erasmus University, Rotterdam, The Netherlands; International Centre for Circulatory Health, NHLI, Imperial College, London, United Kingdom. Electronic address:


The landmark Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) Trial has aided in reducing the area of uncertainty in decision-making between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery in patients with complex coronary artery disease. As part of the SYNTAX Trial, quantification of the coronary artery disease burden was prospectively undertaken by the Heart Team - consisting of at least an interventional cardiologist and cardiac surgeon - utilising the anatomical SYNTAX Score ( as a clinical tool in order to agree that equivalent anatomical revascularisation could be achieved. The anatomical SYNTAX Score is now advocated in both European and US revascularisation guidelines to guide decision-making between CABG and PCI as part of the SYNTAX pioneered Heart Team approach. In addition, the SYNTAX Trial has lead to the development and validation of the SYNTAX Score II, in which the anatomical SYNTAX Score was augmented with clinical variables, to allow for more objective and tailored decision making for the individual patient. Prospective validation of the SYNTAX Score II tool is currently ongoing in the SYNTAX II ( Identifier: NCT02015832) and EXCEL ( identifier: NCT01205776) trials. The present paper presents lessons learned from SYNTAX, including the development and/or validation of several SYNTAX based clinical tools, and the potential implications for current and future clinical practice.


Coronary artery bypass surgery; Coronary artery disease; Percutaneous intervention; Revascularization

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