A study published in the European Heart Journal analyzed whether technical and procedural developments in percutaneous coronary intervention PCI remarkably influence outcomes in appropriately selected patients with 3 vessel 3VD coronary artery disease. It was reported that at 1 year clinical outcomes with the SYNTAX II strategy were improved in contrast to the PCI performed in comparable patients from the original SYNTAX I trial. The SYNTAX II study was a multicenter all comers open label single arm study. The SYNTAX II strategy included heart team decision making using the SYNTAX Score II a clinical tool that combined anatomical as well as clinical factors coronary physiology guided revascularisation implantation of thin strut bioresorbable polymer drug eluting stents intravascular ultrasound guided stent implantation contemporary chronic total occlusion revascularization techniques and guideline directed medical therapy. Of 708 patients who were screened and discussed within the heart team 454 were considered eligible to undergo PCI. At one year the SYNTAX II strategy was superior to the equipoise derived SYNTAX I PCI cohort major adverse cardiac and cerebrovascular events MACCE SYNTAX II vs. SYNTAX I 10.6 vs. 17.4 . This difference was attributed to a marked reduction in the incidences of myocardial infarction and revascularization. However rates of all cause mortality and stroke were similar. The rate of definite stent thrombosis was considerably lower in SYNTAX II.