Concerns with the new SYNTAX score – Authors' reply

We welcome the comments by Nick Freemantle and Domenico Pagano in response to our publication on redevelopment external valida­tion of SYNTAX score II 2020 (SS 2020) for individualised decision making patients with de-novo three-vessel or left main coronary artery disease, both.1Takahashi K Serruys PW Fuster V et al.Redevelopment validation individualise between percutaneous surgical revascularisation complex disease: secondary analysis multicentre randomised controlled SYNTAXES trial cohort validation.Lancet. 2020; 396: 1399-1412Summary Full Text PDF PubMed Scopus (30) Google Scholar First, describing concordance statistics 0·62 0·71 isolation as modest is not meaningful. As noted Discussion section Article,1Takahashi models are helpful when they can separate substantial groups across meaningful risk thresholds. In validation, SS separated low-risk high-risk quarters major adverse cardiovascular event rates under 10% over 30%, respectively. More importantly, was able discriminate low-treatment-benefit high-treatment-benefit patients, absolute differences ?1·2% 9·4%, Second, at time submission (Feb 25, 2020), we had been given any access EXCEL data2Stone GW Kappetein AP Sabik JF al.Five-year outcomes after PCI CABG disease.N Engl J Med. 2019; 381: 1820-1830Crossref (277) industrial sponsor, whereas principal investigators funders three trials—FREEDOM,3Farkouh ME Domanski M Sleeper LA al.Strategies multivessel revascularization diabetes.N 2012; 367: 2375-2384Crossref (1269) BEST,4Park SJ Ahn JM Kim YH al.Trial everolimus-eluting stents bypass surgery 2015; 372: 1204-1212Crossref (303) PRECOMBAT5Park Park DW al.Randomized versus 2011; 364: 1718-1727Crossref (471) Scholar—all agreed share their databases us. noted, corresponding author requested received a trimmed database trial. However, these data, which were necessary construe new score, only became available May 4, 2020, following sponsor's approval send data outside research organisation core laboratory located New York, NY, USA. have now presented results included FREEDOM, BEST, PRECOMBAT, trials. found acceptable calibration treatment benefit grafting intervention (appendix). Currently, do NOBLE trial.6Holm NR Mäkikallio T Lindsay MM al.Percutaneous angioplasty unprotected stenosis: updated 5-year from randomised, non-inferiority trial.Lancet. 395: 191-199Summary (133) careful legal procedure, patient-level meta-ana­lysis SYNTAX, EXCEL, trials currently being done Thrombosis Myocardial Infarction group leadership Eugene Braunwald Marc Sabatine, without involve­ment authorship respective Once meta-analysis completed, further validations including trial, warranted support utility disease. Moreover, believe that ultimate test actually implement model establish whether it improves process medical outcomes.7Steyerberg EW Moons KG van der Windt DA al.Prognosis Research Strategy (PROGRESS) 3: prognostic research.PLoS 2013; 10e1001381Crossref (647) PWS reports personal fees Sino Medical Sciences Technology, Philips/Volcano, Xeltis, SMT, Meril Life, Novartis, unrelated this Correspondence. All other authors declare no competing interests. Download .pdf (.18 MB) Help pdf files Supplementary appendix Redevelopment validationThe predicting 10-year deaths events help identify individuals who will either PCI, thereby supporting heart teams, families select optimal strategies. Full-Text Concerns scoreKuniaki Takahashi colleagues1 attempt revitalise argue has place clinical practice. Unfortunately, flaws weaknesses derivation predicate against such use.