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

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 the SYNTAX score was 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 for MACE (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.