SYNTAX Score II as a Predictor of One-Year Major Adverse Cardiovascular Events in Patients with Chronic Coronary Syndrome and Type 2 Diabetes Mellitus Undergoing Percutaneous Coronary Intervention
DOI:
https://doi.org/10.32734/sumej.v9i2.23616Keywords:
chronic coronary syndrome, major adverse cardiovascular events, syntax II, type 2 diabetes mellitusAbstract
Background: The severity of coronary atherosclerotic lesions is an important determinant of cardiovascular events in patients with CAD. The SS-II (SYNTAX-II) score, which integrates anatomical characteristics with clinical variables, provides improved prognostic value compared with anatomical scoring alone. Objective: To determine whether the SS-II predicts one-year MACE in CCS patients with T2DM who undergo PCI. Methods: This observational analytic study employed a retrospective cohort design including patients treated from June 2023 to August 2024. A total of 128 CCS patients with T2DM who underwent PCI were enrolled. Bivariate and multivariate analyses were performed to examine the association between the SS-II and MACE. One-year MACE-free survival was analyzed using Kaplan–Meier curves. Results: MACE occurred more frequently among patients with high SS-II scores (22 [34.4%], P < 0.001). Mortality and acute heart failure were both significantly associated with the SS-II (P = 0.042 and P = 0.03, respectively). Patients with high scores had significantly lower one-year MACE-free survival. Conclusion: The SS-II is a valuable predictor of one-year MACE in CCS patients with T2DM undergoing PCI.
Downloads
References
[1] World Heart Federation. World Heart Report 2023: Confronting the World’s Number One Killer [Internet]. Geneva (CH): World Heart Federation; 2023 [cited 2025 Jul 24]. Available from: https://world-heart-federation.org/wp-content/uploads/World-Heart-Report-2023.
[2] Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, et al. The SYNTAX score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2005;1(2):219–27.
[3] Farooq V, van Klaveren D, Steyerberg EW, Meliga E, Vergouwe Y, Chieffo A, et al. Anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention: development and validation of SYNTAX score II. Lancet. 2013;381(9867):639–50.
[4] Serruys PW, Onuma Y, Garg S, Sarno G, van den Brand M, Kappetein AP, et al. Assessment of the SYNTAX score in the SYNTAX study. EuroIntervention. 2009;5(1):50–6.
[5] Yuksel Y, Yildiz C, Kose S. Predictive value of SYNTAX II score for adverse cardiac events in acute coronary syndrome. Angiology. 2024;75(8):754–63.
[6] Scudeler TL, Farkouh ME, Hueb WA. Coronary atherosclerotic burden assessed by SYNTAX scores and outcomes: retrospective cohort study. BMJ Open. 2022;12(8):e062378.
[7] Cavalcante R, Sotomi Y, Lee CW, Ahn JM, Farooq V, Onuma Y, et al. Impact of SYNTAX scores I and II in diabetes with multivessel disease. Eur Heart J. 2017;38(24):1969–77.
[8] Esper RB, Farkouh ME, Rosenberg S, Marso SP, Sabik JF, Kapadia SR, et al. SYNTAX score in diabetes patients undergoing coronary revascularization in the FREEDOM trial. J Am Coll Cardiol. 2018;72(23 Pt A):2826–37.
[9] Kang J, Han JK, Kang DY, Zheng C, Yang HM, Park KW, et al. SYNTAX score and SYNTAX score II predict outcomes in left main or three-vessel disease undergoing PCI. Korean Circ J. 2020;50(1):22–34.
[10] Brener SJ, Alapati V, Chan D, Da Wariboko A, Kaid Y, Latyshev Y, et al. SYNTAX II score predicts 4-year mortality in PCI patients. J Invasive Cardiol. 2018;30(8):290–4.
[11] Satheesh S, Kumar R, Pillai A, Ganapathi S, Selvaraj RJ. Prognostic values of SYNTAX score II in patients with coronary artery disease undergoing percutaneous coronary intervention: cohort study. Indian Heart J. 2024;76(2):108–12.
[12] Papadopoulos K, Lekakis I, Katsanos S, Pappas C, Karatasakis G, Gerasimou A, et al. The predictive value of the SYNTAX score in patients with chronic coronary artery disease undergoing percutaneous coronary intervention or coronary artery bypass grafting: a pilot study. Open Cardiovasc Med J. 2017;11:29–35.
[13] Askin L, Tanriverdi O. The clinical value of SYNTAX scores in predicting coronary artery disease outcomes. Cardiovasc Innov Appl. 2022;6(4):197–208.
[14] Després JP, Lemieux I, Bergeron J, Pibarot P, Mathieu P, Larose E, et al. Abdominal obesity and metabolic syndrome: contribution to cardiometabolic risk. Circulation. 2008;118(6):1301–13.
[15] Campos CM, van Klaveren D, Farooq V, Simonton CA, Kappetein AP, Sabik JF, et al. Predictive performance of SYNTAX score II in patients with left main and multivessel coronary artery disease. Circ J. 2014;78(8):1942–9.
[16] Song Y, Gao Z, Tang X, Ma Y, Jiang P, Xu J, et al. SYNTAX score II to validate 2-year outcomes in complex coronary disease after PCI. Catheter Cardiovasc Interv. 2018;92(1):40–7.
[17] Samsul H, Siregar S, Lubis L, Hasan R. SYNTAX II score as a predictor of major adverse cardiovascular events in patients undergoing coronary artery bypass surgery during treatment at Haji Adam Malik Hospital, Medan. Int J Res Sci Manag. 2021;8(11):1–7.
[18] Kang J, Han JK, Kang DY, Zheng C, Yang HM, Park KW, et al. SYNTAX score and SYNTAX score II predict outcomes in patients with left main and/or three-vessel disease undergoing PCI. Korean Circ J. 2020;50(1):22–34.
[19] Kocas BB, Cetinkal G, Kocas C, Arslan S, Abaci O, Dalgic Y, et al. SYNTAX score II predicts in-hospital and long-term mortality in STEMI undergoing primary PCI. Med Bull Sisli Hosp. 2022;56(2):182–8.
[20] Azzarelli S, Boukhris M, Giubilato S, Tomasello SD, Castaing M, Giunta R, et al. Usefulness of SYNTAX Score II in complex percutaneous coronary interventions in acute coronary syndrome. J Saudi Heart Assoc. 2016;28(2):63–72.
[21] Wang G, Wang C, Zhang Y, Wang P, Ran C, Zhao L, et al. Usefulness of the SYNTAX score II to predict 1-year outcome in primary percutaneous coronary intervention. Coron Artery Dis. 2016;27(6):483–9.
[22] Banning AP, Serruys P, De Maria GL, Ryan N, Walsh S, Gonzalo N, et al. Five-year outcomes after PCI in de novo three-vessel disease: SYNTAX II final results. Eur Heart J. 2022;43(13):1307–16.
[23] Cid-Álvarez AB, Rodríguez-Ruiz C, Abu-Assi E, Barreiro-Pardal B, López-López R, Guedes IC, et al. Prognostic impact of SYNTAX II score in STEMI patients undergoing primary PCI: four-year registry analysis. EuroIntervention. 2019;15(9):e796–e803.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Sumatera Medical Journal

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
The Authors submitting a manuscript do so on the understanding that if accepted for publication, copyright of the article shall be assigned to Sumatera Medical Journal (SUMEJ) and Faculty of Medicine as well as TALENTA Publisher Universitas Sumatera Utara as publisher of the journal.
Copyright encompasses exclusive rights to reproduce and deliver the article in all form and media. The reproduction of any part of this journal, its storage in databases and its transmission by any form or media, will be allowed only with a written permission from Sumatera Medical Journal (SUMEJ).
The Copyright Transfer Form can be downloaded here.
The copyright form should be signed originally and sent to the Editorial Office in the form of original mail or scanned document.








