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Aims We studied the effect of residue SYNTAX score (rSS) on patients with stable and three-vessel CAD underwent pereutaneous coronary intervention (PCI).Methods and results A total of 558 patients with stable and three-vessel coronary artery disease who underwent PCI were enrolled.Complete revascularization (CR) wasdefined as rSS=0.Patients with IR (rSS≥1)were grouped in tertiles of rSS for analysis and compared tothose with CR.CR (rSS=0) was achieved in 51 patients (9.1%).Among patients with IR (rSS>0,n=507), by tertile grouping 174 patients had rSS>0 but≤8 , 158 had rSS>8 but≤16, and175 patients had rSS>16.The median follow-up was 56.9 months.Patients with CR suffered worse prognosis compared with patients with IR.Among patients with IR, patients with rSS>16 had the lowest incidence of MACE(major adverse cardiovascular event).By multivariable analysis, residue syntax score is inversely associated with adverse outcome(MACE, P<0.001; target vessel failure, P<0.001; cardiac death, P=0.02; myocardial infarction,P<0.001; repeat revascularization, P=0.003).Conclusion In patients with stable and three-vessel CAD underwent PCI, residue syntax score was found to be inversely associated with adverse outcome.