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The Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score was designed to predict the post-procedural risk associated with percutaneous coronary intervention (PCI) or surgical revascularization. This study aimed to evaluate the long-term outcomes of PCI and coronary artery bypass grafting (CABG) by comparing several existing studies. A systematic search was performed using the PubMed (MEDLINE) and ScienceDirect databases. This systematic review included studies that examined differences in the outcomes of PCI and CABG for left main coronary artery (LMCA) stenosis. This was a systematic review study in which we reviewed original cross-sectional and cohort studies. The search was conducted from February 1st until February 2nd, 2023. The quality assessment of the studies was carried out using the criteria outlined in the Newcastle-Ottawa Scale (NOS). According to the final assessment, all the original research included had a mean NOS score of 8, indicating excellent quality. The literature search yielded 1,675 studies, five of which were selected for the final analysis. A total of 5,494 patients underwent PCI and CABG. This study found that there were variations in outcomes among patients with low, medium, and high SYNTAX scores for long-term major adverse cardiac or cerebrovascular events (MACCE) and long-term mortality. However, similar outcomes were observed in long-term revascularization, long-term stroke, and long-term myocardial infarction (MI). This study concluded that patients with LMCA stenosis and SYNTAX scores ranging from low to high may have different long-term outcomes. CABG is associated with a lower incidence of mortality, repeat revascularization, MI, and MACCE compared to PCI. On the other hand, an association exists between PCI and a lower incidence of stroke.


Syntax score; Percutaneous Coronary Intervention; Coronary Artery Bypass Grafting; Left Main Coronary Artery Disease; Outcome

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How to Cite
Murteza, F., Chabib Fachry Albab, Almas Talida Habibah, Achmad Fayyad Mas’udi, Vemaniarti Lian Pravitasari, Arya Satya Rajanagara, & Zaha El-Ma’i. (2023). The Impact of SYNTAX Scores on the Long-Term Outcomes of Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention for Left Main Coronary Artery Disease. Folia Medica Indonesiana, 59(4), 418–427.


  1. Bonzel T, Schächinger V, Dörge H (2016). Description of a Heart Team approach to coronary revascularization and its beneficial long-term effect on clinical events after PCI. Clin Res Cardiol.;105:388–400. (doi : 10.1007/s00392-015-0932-2)
  2. Chew NWS, Koh JH, Ng CH, et al (2022). Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention for Multivessel Coronary Artery Disease: A One-Stage Meta-Analysis. Front Cardiovasc Med. 2022;9:822228.. doi:10.3389/fcvm.2022.822228 (
  3. FW Mohr, MC Morice, AP Kappetein, et al (2013). Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet 381: 629–38 (
  4. H Shiomi, T Morimoto, Y Furukawa et al (2015). Comparison of Percutaneous Coronary Intervention With Coronary Artery Bypass Grafting in Unprotected Left Main Coronary Artery Disease 5 Year Outcome From CREDO-Kyoto PCI/CABG Registry Cohort 2. Circ J 2015; 79: 1282–1289 (doi:10.1253/circj.CJ-15-0034)
  5. He YM, Shen L, Ge JB (2020). Fallacies and Possible Remedies of the SYNTAX Score. J Interv Cardiol.; 8822308.
  6. Head SJ, Milojevic M, Daemen J, Ahn JM, Boersma E, Christiansen EH, et al (2018). Stroke Rates Following Surgical Versus Percutaneous Coronary Revascularization. Journal of the American College of Cardiology. 72(4):386–98.
  7. Head SJ, Milojevic M, Daemen J, Ahn J-M, Boersma E, Christiansen EH, Domanski MJ, Farkouh ME, Flather M, Fuster V, et al (2018). Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data. Lancet. 391:939–948. (doi: 10.1016/S0140 -6736(18)30423-9)
  8. Jahangiri M et al (2020). The EXCEL Trial: The Surgeons’ Perspective. European Cardiology Review (doi : 10.15420/ecr.2020.34)
  9. Lee J, Ahn JM, Kim JH et al et al (2021). Prognostic Effect of the SYNTAX Score on 10-Year Outcomes After Left Main Coronary Artery Revascularization in a Randomized Population: Insights From the Extended PRECOMBAT Trial. J Am Heart Assoc. 2021;10:e020359. (doi: 10.1161/JAHA.120.020359)
  10. Lee PH, Ahn JM, Chang M, et al (2016). Left main coronary artery disease: secular trends in patient characteristics, treatments, and outcomes. J Am Coll Cardiol;68:1233–46. (doi : 10.1016/j.jacc.2016.05.089)
  11. Makikallio T, Holm NR, Lindsay M, et al (2016). Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial. Lancet;388:2743–52. (doi : 10.1016/S0140-6736(16)32052-9)
  12. Mehta SR, Wood DA, Storey RF, et al (2019). Complete revascularization with multivessel PCI for myocardial infarction. N Engl J Med.;381:1411–1421. (doi : 10.1056/NEJMoa1907775)
  13. MC Morice, Patrick WS, Pieter K et al (2014). Five-Year Outcomes in Patients With Left Main Disease Treated With Either Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting in the Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery Trial. American Heart Association (DOI: 10.1161/CIRCULATIONAHA.113.006689)
  14. Neumann FJ, Sousa-Uva M, Ahlsson A, et al (2018) ESC/EACTS guidelines on myocardial revascularization. Eur Heart J ;40:87–165 (doi:10.1093/eurheartj/ehy394)
  15. Park DW, Park SJ (2017). Percutaneous coronary intervention of left main disease: pre- and postEXCEL (Evaluation of XIENCE Everolimus Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) and NOBLE (Nordic-Baltic-British Left Main Revascularization Study) era. Circ Cardiovasc Interv (doi : 10.1161/CIRCINTERVENTIONS.117.004792)
  16. Park D-W, Ahn J-M, Park H, Yun S-C, Kang D-Y, Lee PH, Kim Y-H, Lim D-S, Rha S-W, Park G-M, et al (2020). Ten-year outcomes after drug-eluting stents versus coronary artery bypass grafting for left main coronary disease: extended follow-up of the PRECOMBAT trial. Circulation. ;141:1437–1446. (doi: 10.1161/CIRCULATIONAHA.120.046039)
  17. Shlofmitz E, Généreux P, Chen S, Dressler O, Ben-Yehuda O, Morice MC, et al (2019). Left Main Coronary Artery Disease Revascularization According to the SYNTAX Score. Circulation: Cardiovascular Interventions (doi : 10.1161/CIRCINTERVENTIONS.118.008007)
  18. Stone GW, Kappetein AP, Sabik JF, Pocock SJ, Morice M-C, Puskas J, Kandzari DE, Karmpaliotis D, Brown WM III, Lembo NJ, et al (2019). Five-year outcomes after PCI or CABG for left main coronary disease. N Engl J Med.;381:1820–1830. (doi: 10.1056/NEJMoa1909406)
  19. Takahashi K, Serruys PW, Fuster V, Farkouh ME, Spertus JA, Cohen DJ, et al (2020). Redevelopment and validation of the SYNTAX score II to individualise decision making between percutaneous and surgical revascularisation in patients with complex coronary artery disease: secondary analysis of the multicentre randomised controlled SYNTAXES trial with external cohort validation. The Lancet. (10260):1399–412 (doi : 10.1016/S0140-6736(20)32114-0)
  20. Yoon YH, Ahn JM, Kang DY et al (2020). Impact of SYNTAX Score on 10-Year Outcomes After Revascularization for Left Main Coronary Artery Disease. JACC: CARDIOVASCULAR INTERVENTIONS VOL. 13 (