The SYNTAX (SYNergy between PCI with TAXUS™ and Cardiac Surgery) study was designed to assess the optimal revascularization strategy for patients with de novo three-vessel coronary artery disease (CAD) and/or left main (LM) disease by either coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI) with the TAXUS drug-eluting stent (DES). The trial was a multi-center, prospective, randomized, “all-comer” clinical trial [12] . The SYNTAX score as part of the SYNTAX trial was derived from multiple previously established coronary lesion scoring systems and designed specifically to correlate anatomy complexity with clinical outcomes [23] . The SYNTAX score integrates the coronary vessel characteristics to establish the degree of myocardium in jeopardy and the technical success of addressing each lesion [2] . Higher SYNTAX scores indicate more complex disease and portend a worse prognosis [2] . Initial validation was performed by applying the SYNTAX score retrospectively to 1292 lesions in 306 patients who had undergone PCI for three-vessel disease in ARTS-II (Arterial Revascularization Therapies Study part II). Thirty-day results showed an almost linear increase in major adverse cardiac or cerebrovascular events (MACCE) for patients with an increasing SYNTAX score from low (≤18) to intermediate (19–26) to high (≥26), 3% vs 5% vs 12% ( p = 0.03), driven primarily by periprocedural myocardial infarction (MI) ( p = 0.04) and target vessel revascularization (TVR) ( p = 0.02) [4] . The predictive ability in patients undergoing PCI with regard to death and MACCE during long-term follow-up was strong while, in contrast, in patients undergoing CABG, it lacked prognostic power [25] .