***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIMS Coronary artery bypass grafting ( CABG ) has been considered the st and ard of care for patients with three-vessel disease ( 3VD ) , but long-term comparative results from r and omized trials of CABG vs. percutaneous coronary intervention ( PCI ) using drug-eluting stents ( DES ) remain limited . METHODS AND RESULTS Patients with de novo 3VD or left main disease were r and omly assigned to PCI with the paclitaxel-eluting first-generation stent or CABG in the SYNTAX trial . This pre-specified analysis presents the 5-year outcomes of patients with 3VD ( n = 1095 ) .  The rate of major adverse cardiac and cerebrovascular events ( MACCE ) was significantly higher in patients with PCI compared with CABG  ( 37.5 vs. 24.2 % , respectively ; P < 0.001 ) . Percutaneous coronary intervention as opposed to CABG result ed in significantly higher rates of the composite of death/stroke/myocardial infa rct ion ( MI ) ( 22.0 vs. 14.0 % , respectively ; P < 0.001 ) , all-cause death ( 14.6 vs. 9.2 % , respectively ; P = 0.006 ) , MI ( 9.2 vs. 4.0 % , respectively ; P = 0.001 ) , and repeat revascularization ( 25.4 vs. 12.6 % , respectively ; P < 0.001 ) ; however , stroke was similar between groups at 5 years ( 3.0 vs. 3.5 % , respectively ; P = 0.66 ) . Results were dependent on lesion complexity ( P for interaction = 0.12 ) ; in patients with a low ( 0 - 22 ) SYNTAX score , PCI vs. CABG result ed in similar rates of MACCE ( 33.3 % vs. 26.8 % , respectively ; P = 0.21 ) but significantly more repeat revascularization ( 25.4 % vs. 12.6 % , respectively ; P = 0.038 ) , while in intermediate ( 23 - 32 ) or high ( ≥ 33 ) SYNTAX score terciles , CABG demonstrated clear superiority in terms of MACCE , death , MI , and repeat revascularization . Differences in MACCE between PCI and  CABG were larger in diabetics [ hazard ratio ( HR ) = 2.30 ] than non-diabetics ( HR = 1.51 ) , although the P for interaction failed to reach significance for MACCE ( P for interaction = 0.095 ) or any of the other endpoints . CONCLUSION Five-year results of patients with 3VD treated with CABG or PCI  using the first-generation paclitaxel-eluting DES suggest that CABG should remain the st and ard of care as it result ed in significantly lower rates of death , MI , and repeat revascularization , while stroke rates were similar . For patients with low SYNTAX scores , PCI is an acceptable revascularization strategy , although at a price of significantly higher rates of repeat revascularization . CLINICAL TRIAL REGISTRATION NCT00114972 Although coronary artery disease ( CAD ) is common in patients with heart failure ( HF ) , little is known about the prognostic significance of coronary lesion complexity in patients with prior HF undergoing percutaneous coronary intervention ( PCI ) . The aim of this study was to investigate whether the coronary Synergy between Percutaneous Coronary Intervention with TAXus and Cardiac Surgery ( SYNTAX ) score could improve risk stratification in HF patients with CAD . Two hundred patients ( mean age 73 ± 11 years , left ventricular ejection fraction 49 ± 15 % ) with prior HF who underwent PCI  were divided into two groups stratified by SYNTAX score ( median value 12 ) and tracked prospect ively for 1 year . The study endpoint was the composite of major adverse cardiovascular events ( MACE ) , including all-cause death , myocardial infa rct ion , stroke , and hospitalization for worsening HF . Adverse events were observed in 39 patients ( 19.5 % ) . Patients with high SYNTAX scores ( n = 100 ) showed worse prognoses than those with low scores ( n = 100 ) ( 26.0 vs. 13.0 % , respectively , P = 0.021 ) . In multivariate Cox-regression analysis , SYNTAX score ≥12 was significantly associated with MACE ( hazard ratio : 1.99 , 95 % confidence interval : 1.02–3.97 ; P = 0.045 ) . In patients with prior HF and CAD , high SYNTAX scores predicted a high incidence of MACE . These results suggest that the SYNTAX score might be a useful parameter for improving risk stratification in these patients Background The revascularization strategy of the left main disease is determinant for clinical outcomes . Objective We sought to 1 ) vali date and compare the performance of the SYNTAX Score 1 and 2 for predicting major cardiovascular events at 4 years in patients who underwent unprotected left main angioplasty  and 2 ) evaluate the long-term outcome according to the SYNTAX score 2-recommended revascularization strategy . Methods We retrospectively studied 132 patients from a single-centre registry who underwent unprotected left main angioplasty between March 1999 and December 2010 . Discrimination and calibration of both models were assessed by ROC curve analysis , calibration curves and the Hosmer-Lemeshow test . Results Total event rate was 26.5 % at 4 years . The AUC for the SYNTAX Score 1 and SYNTAX Score 2 for percutaneous coronary intervention , was 0.61 ( 95 % CI : 0.49 - 0.73 ) and 0.67 ( 95 % CI : 0.57 - 0.78 ) , respectively . Despite a good overall adjustment for both models , the SYNTAX Score 2 tended to underpredict risk . In the 47 patients ( 36 % ) who should have undergone surgery according to the SYNTAX Score 2 , event rate was numerically higher ( 30 % vs. 25 % ; p=0.54 ) , and for those with a higher difference between the two SYNTAX Score 2 scores ( Percutaneous coronary intervention vs. Coronary artery by-pass graft risk estimation greater than 5.7 % ) , event rate was almost double ( 40 % vs. 22 % ; p=0.2 ) . Conclusion The SYNTAX Score 2 may allow a better and individualized risk stratification of patients who need revascularization of an unprotected left main coronary artery . Prospect i ve studies are needed for further validation OBJECTIVES This study aim ed to compare the NERS ( New Risk Stratification ) and SYNTAX ( Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery ) scores for prognostication after stenting of unprotected left main stenosis in a " real-world " setting . BACKGROUND In contrast to existing systems , the NERS score encompasses clinical , procedural , and angiographic characteristics . METHODS The NERS score was derived from 260 patients with unprotected left main stenosis who underwent percutaneous coronary intervention and tested in 337 patients in a consecutive left main registry ( 66.55 + /- 10.49 years , 78.9 % men ) undergoing percutaneous coronary intervention in a prospect i ve , multicenter trial . Six-month clinical and angiographic follow-up was obtained in 100 % and 88.9 % of patients , respectively . The primary end point was major adverse cardiac events ( MACE ) , encompassing myocardial infa rct ion , all-cause death , and target vessel revascularization . Receiver-operator characteristic ( ROC ) curve was generated for the comparison of NERS versus SYNTAX scores . RESULTS The NERS score consisted of 54 variables ( 17 clinical , 4 procedural , and 33 angiographic ) . A NERS score > or = 25 demonstrated a sensitivity and specificity of 92.0 % and 74.1 % ( MACE as state variable ) , respectively , significantly higher than SYNTAX intermediate risk ( 20.5 % and 25.4 % ) or SYNTAX higher risk ( 70.5 % and 35.2 % , p for all < 0.001 ) . At follow-up , myocardial infa rct ion , cardiac death , and target vessel revascularization occurred in 3.0 % , 5.6 % , and 13.1 % of patients , respectively , for a composite MACE of 26.0 % . A NERS score > or = 25 ( hazard ratio : 1.13 ; 95 % confidence interval [ CI ] : 1.11 to 1.16 ; p < 0.001 ) was the only independent predictor of cumulative MACE and stent thrombosis at follow-up ( odds ratio : 31.04 ; 95 % CI : 19.36 to 67.07 ; p < 0.001 ) . CONCLUSIONS The NERS score was more predictive of MACE than the SYNTAX score was . Further study is needed to address their relative roles in assessment for appropriateness of coronary artery bypass graft versus percutaneous coronary intervention for unprotected left main coronary artery stenosis BACKGROUND Patients with obstructive left main coronary artery disease are usually treated with coronary-artery bypass grafting ( CABG ) . R and omized trials have suggested that drug-eluting stents may be an acceptable alternative to CABG in selected patients with left main coronary disease . METHODS We r and omly assigned 1905 eligible patients with left main coronary artery disease of low or intermediate anatomical complexity to undergo either percutaneous coronary intervention ( PCI ) with fluoropolymer-based cobalt-chromium everolimus-eluting stents ( PCI group , 948 patients ) or CABG ( CABG group , 957 patients ) . Anatomic complexity was assessed at the sites and defined by a Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery ( SYNTAX ) score of 32 or lower ( the SYNTAX score reflects a comprehensive angiographic assessment of the coronary vasculature , with 0 as the lowest score and higher scores [ no upper limit ] indicating more complex coronary anatomy ) . The primary end point was the rate of a composite of death from any cause , stroke , or myocardial infa rct ion at 3 years , and the trial was powered for noninferiority testing of the primary end point ( noninferiority margin , 4.2 percentage points ) . Major secondary end points included the rate of a composite of death from any cause , stroke , or myocardial infa rct ion at 30 days and the rate of a composite of death , stroke , myocardial infa rct ion , or ischemia-driven revascularization at 3 years . Event rates were based on Kaplan-Meier estimates in time-to-first-event analyses . RESULTS At 3 years , a primary end-point event had occurred in 15.4 % of the patients in the PCI group and in 14.7 % of the patients in the CABG group ( difference , 0.7 percentage points ; upper 97.5 % confidence limit , 4.0 percentage points ; P=0.02 for noninferiority ; hazard ratio , 1.00 ; 95 % confidence interval , 0.79 to 1.26 ; P=0.98 for superiority ) . The secondary end-point event of death , stroke , or myocardial infa rct ion at 30 days occurred in 4.9 % of the patients in the PCI group and in 7.9 % in the CABG group ( P<0.001 for noninferiority , P=0.008 for superiority ) . The secondary end-point event of death , stroke , myocardial infa rct ion , or ischemia-driven revascularization at 3 years occurred in 23.1 % of the patients in the PCI group and in 19.1 % in the CABG group ( P=0.01 for noninferiority , P=0.10 for superiority ) . CONCLUSIONS In patients with left main coronary artery disease and low or intermediate SYNTAX scores by site assessment , PCI with everolimus-eluting stents was noninferior to CABG with respect to the rate of the composite end point of death , stroke , or myocardial infa rct ion at 3 years . ( Funded by Abbott Vascular ; EXCEL Clinical Trials.gov number , NCT01205776 . ) OBJECTIVES We aim ed to assess the predictive value of the SYNTAX score ( SXscore ) for major adverse cardiac events in the all-comers population of the LEADERS ( Limus Eluted from A Durable versus ERodable Stent coating ) trial . BACKGROUND The SXscore has been shown to be an effective predictor of clinical outcomes in patients with multivessel disease undergoing percutaneous coronary intervention . METHODS The SXscore was prospect ively collected in 1,397 of the 1,707 patients enrolled in the LEADERS trial ( patients after surgical revascularization were excluded ) . Post hoc analysis was performed by stratifying clinical outcomes at 1-year follow-up , according to 1 of 3 SXscore tertiles . RESULTS The 1,397 patients were divided into tertiles based on the SXscore in 
    Output:
    
In terms of clinical outcomes , this analysis showed PCI to have significantly favored patients with a low versus a high SYNTAX score .
In patients who were re-vascularized by CABG , mortality and major adverse cardiac events were significantly lower with a low SYNTAX score .
In conclusion , the SYNTAX score might be considered useful in interventional cardiology .