Favorable Long-Term Survival in Patients Undergoing Stent PCI of Unprotected Left Main Coronary Artery Compared to Predicted Short-Term Prognosis of CABG Estimated by EuroSCORE: Clinical Determinants of Long-Term Outcome

Department of Cardiology, Johann Wolfgang Goethe-University Frankfurt, D-60590 Frankfurt, Germany.
Journal of Interventional Cardiology (Impact Factor: 1.18). 08/2009; 22(4):311-9. DOI: 10.1111/j.1540-8183.2009.00480.x
Source: PubMed


The long-term outcome of patients (pts) undergoing percutaneous coronary intervention (PCI) of unprotected left main coronary artery (LMCA) is unclear so far. We prospectively investigated the outcome of 102 consecutive patients who underwent stent PCI of unprotected LMCA. Patients were divided according to clinical indication for PCI: stable coronary artery disease (CAD) (N = 60), NSTEMI (N = 18), STEMI (N = 24). Expected in-hospital mortality of coronary artery bypass grafting (CABG) was calculated using the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and compared to the observed survival rate during long-term follow-up (mean 1.8 +/- 1.2 years).
The observed 30-day mortality was 1.7% (1/60 pts) in patients with stable CAD, 11% (2/18 pts) in NSTEMI patients, and 13% (3/24 pts) in STEMI patients. The observed mortality was lower than the predicted mortality of CABG as calculated by the logistic EuroSCORE. Using receiver-operator characteristics curves (ROC), EuroSCORE demonstrated a high predictive value for both 30-day mortality as well as 1-year mortality (AUC > 0.8; P < 0.01). Prognostically relevant patient related factors (P < 0.01) included severely reduced left ventricular ejection fraction (HR 3.24), ACS (HR 3.18), STEMI (HR: 3.01), Killip class IV (HR 7.69), occurrence of neoplastic disease (HR 3.97), and elevated CRP (HR 3.86).
LMCA-PCI was associated with lower long-term mortality rates compared to the estimated mortality of CABG. This prospective observational study suggests that DES-PCI of unprotected LMCA in "all-comers" can be carried out with reasonable risk.

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    • "The European System for Cardiac Operative Risk Evaluation (EuroSCORE), one such tool used for patients undergoing cardiac surgery [1], evaluates the risk of postoperative mortality by integrating several clinical and procedural factors. It has gained wide popularity because of its simplicity, and is used not only for cardiac surgery but also for percutaneous coronary intervention (PCI) [2] [3]. Because it has been suggested that EuroSCORE often overestimates postoperative mortality [4] [5], the EuroSCORE II was created to achieve better calibration than the original [6]. "
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    ABSTRACT: We evaluated the usefulness of the combination of European System for Cardiac Operative Risk Evaluation score (EuroSCORE II) and SYNergy between percutaneous intervention with TAXus drug-eluting stents and cardiac surgery (SYNTAX) score in predicting risks associated with early and late outcomes after coronary artery bypass grafting (CABG). Between January 2010 and April 2012, 412 patients underwent isolated CABG at our institution. EuroSCORE II and SYNTAX score were calculated retrospectively, and their ability to predict early and long-term outcomes was evaluated. Patients were divided into four groups according to median EuroSCORE II and SYNTAX score: Group 1, low EuroSCORE II, low SYNTAX (n = 103); Group 2, low EuroSCORE II, high SYNTAX (n = 103); Group 3, high EuroSCORE II, low SYNTAX (n = 99); and Group 4, high EuroSCORE II, high SYNTAX (n = 107). Operative death was not different among the groups; however, Group 4 had the highest major complication rate of the four groups (0 in Group 1, 2.9% in Group 2, 3.0% in Group 3 and 8.4% in Group 4; P = 0.011). Multivariate analyses revealed that both high EuroSCORE II (odds ratio [OR]: 4.154; P = 0.030) and high SYNTAX score (OR: 3.988; P = 0.035) were independent predictors of postoperative major complications and that high EuroSCORE II was an independent predictor of late mortality (OR: 4.673; P = 0.016) but high SYNTAX score was not (OR: 0.808; P = 0.662). Actuarial survival rate at 3 years was the lowest in Group 4 (99.0 ± 1.0% in Group 1, 97.7 ± 1.6% in Group 2, 91.9 ± 2.7% in Group 3 and 90.5 ± 4.7% in Group 4; P = 0.045). The combination of EuroSCORE II and SYNTAX score was useful in predicting early major complications after CABG. In the long term, EuroSCORE II continued to be associated with late mortality, but SYNTAX score did not.
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    • "Recently, the EuroSCORE failed to predict the outcome following TAVI in the SOURCE registry [12]. However, it could be shown that the EuroSCORE predicts the long-term survival after complex percutaneous coronary interventions [13] [14], although it was not similarly validated for such procedures. "
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