Combination of angiographic and clinical characteristics for the prediction of clinical outcomes in patients undergoing unprotected left main coronary artery stenting

Abstract

Background Risk stratification is essential for the clinical decision-making process in patients undergoing revascularization of the unprotected left main coronary artery (ULMCA), since the optimal revascularization strategy still remains subject of ongoing debate. Objectives To assess the prognostic value of angiographic versus clinical characteristics for the prediction of major adverse cardiac events (MACE) and to develop a combined risk model. Methods In 115 patients, who were followed up for MACE after ULMCA stenting, SYNTAX score and EuroSCORE have been calculated for a combined risk model. Results Whereas theSYNTAXscorewas not able to predict MACE at 1 year (32.8 ± 11.7 vs. 29.1 ± 12.2, P = 0.13), the logistic EuroSCORE was significantly increased in these patients suffering a MACE at 1 year [11.9 (4.4/22.6) vs. 4.8 (2.3/14.6)%, P = 0.007]. With ROC curve validated cut-off values, the combination of EuroSCORE (>7.5%) and SYNTAX score (>25) provided incremental predictive value for risk stratification of ULMCA patients (AUC 0.71, 95% CI 0.62-0.79, p < 0.001). This combined risk model was associated with the rate of cardiac mortality (P = 0.04), non-fatal myocardial infarction (P = 0.005), and target lesion revascularization (P = 0.04) and was superior to the SYNTAX score alone (P = 0.03). High risk patients had a 7.1-fold higher risk forMACE (HR 7.1. 95%CI 2.1-24.1, P = 0.002) after 1 year. Conclusions For adequate risk assessment in ULMCA patients, consideration of both comorbidities and coronary anatomic complexity, is essential. A combination of angiographic and clinical risk scores improves the prognostic value for the prediction of 1-year MACE risk and is superior to stand-alone scores. © Springer-Verlag 2012.