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This open-label, nonrandomized study reports that PCI using the SYNTAX-II strategy was associated with superior clinical outcomes compared with the PCI arm of the original SYNTAX-I trial, with a lower incidence of MACCE driven by a reduction in MI, revascularization, and definite stent thrombosis at 1-year follow-up. Importantly, physiological assessment, which was feasible in 75% of lesions, contributed to deferring treatment in 25% of the interrogated stenosis. An exploratory analysis at 1 year suggests that PCI with the SYNTAX-II strategy was associated with similar clinical outcomes to the equipoise-derived SYNTAX-I CABG cohort. While the initial results of SYNTAX II provide evidence of the impact of the technological developments in the field of PCI on clinical outcomes, longer-term follow-up is indicated to determine whether the noninferiority of PCI using the SYNTAX-II strategy compared with CABG is maintained. A randomized clinical trial of contemporary PCI versus CABG will be needed to provide definitive evidence of equivalence.
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