Correspondence to: Adnan Kastrati, MD, Deutsches Herzzentrum München, Lazzarettstrasse 36, 80636, Munich, Germany. E-mail: [email protected]Search for more papers by this author

Erion Xhepa MD,

Erion Xhepa MD

orcid.org/0000-0002-0728-2819

Deutsches Herzzentrum, Technische Universität München, Munich, Germany

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Tomohisa Tada MD,

Tomohisa Tada MD

Deutsches Herzzentrum, Technische Universität München, Munich, Germany

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Sebastian Kufner MD,

Sebastian Kufner MD

Deutsches Herzzentrum, Technische Universität München, Munich, Germany

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Gjin Ndrepepa MD,

Gjin Ndrepepa MD

Deutsches Herzzentrum, Technische Universität München, Munich, Germany

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Robert A. Byrne MB BcH, PhD,

Robert A. Byrne MB BcH, PhD

Deutsches Herzzentrum, Technische Universität München, Munich, Germany

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Johanna Kreutzer MD,

Johanna Kreutzer MD

Deutsches Herzzentrum, Technische Universität München, Munich, Germany

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Tareq Ibrahim MD,

Tareq Ibrahim MD

Medizinische Klinik, Klinikum rechts der Isar, Technische Universität Muenchen, Munich, Germany

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Klaus Tiroch MD,

Klaus Tiroch MD

Helios Clinic Wuppertal, Med. Klinik 3 – Kardiologie, Wuppertal, Germany

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Marco Valgimigli MD, PhD,

Marco Valgimigli MD, PhD

Thoraxcenter, Ba 587, Erasmus MC, Rotterdam, the Netherlands

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Ralf Tölg MD,

Ralf Tölg MD

Herzzentrum, Kardiologie, Segeberger Kliniken, Bad Segeberg, Germany

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Salvatore Cassese MD, PhD,

Salvatore Cassese MD, PhD

Deutsches Herzzentrum, Technische Universität München, Munich, Germany

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Massimiliano Fusaro MD,

Massimiliano Fusaro MD

Deutsches Herzzentrum, Technische Universität München, Munich, Germany

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Heribert Schunkert MD,

Heribert Schunkert MD

Deutsches Herzzentrum, Technische Universität München, Munich, Germany

DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich, Germany

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Karl L. Laugwitz MD,

Karl L. Laugwitz MD

Medizinische Klinik, Klinikum rechts der Isar, Technische Universität Muenchen, Munich, Germany

DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich, Germany

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Julinda Mehilli MD,

Julinda Mehilli MD

DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich, Germany

Klinikum der Universität München; Medizinische Klinik I, Munich, Germany

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Adnan Kastrati MD,

Corresponding Author

Adnan Kastrati MD

[email protected]

Deutsches Herzzentrum, Technische Universität München, Munich, Germany

DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich, Germany

Correspondence to: Adnan Kastrati, MD, Deutsches Herzzentrum München, Lazzarettstrasse 36, 80636, Munich, Germany. E-mail: [email protected]Search for more papers by this author

First published: 12 August 2016

https://doi.org/10.1002/ccd.26645

Citations: 4

Conflict of interest: Nothing to report.

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Abstract

Objectives

To evaluate the long-term prognostic value of risk scores in the setting of drug-eluting stent (DES) implantation for uLMCA.

Background

Data on the prognostic value of novel risk scores developed to select the most appropriate revascularization strategy in patients undergoing DES implantation for uLMCA disease are relatively limited.

Methods

The study represents a patient-level pooled analysis of the ISAR-LEFT-MAIN (607 patients randomized to paclitaxel-eluting or sirolimus-eluting stents) and the ISAR-LEFT-MAIN-2 (650 patients randomized to everolimus-eluting or zotarolimus-eluting stents) randomized trials. The Syntax Score (SxScore) as well the Syntax Score II (SS-II), the EuroSCORE and the Global Risk Classification (GRC) were calculated. The primary outcome was all-cause mortality.

Results

At a mean follow-up of 3 years there were 160 deaths (12.7%). The death-incidence was significantly higher in the upper tertiles than in the intermediate or lower ones for all risk scores (log-rank test P < 0.01 for all comparisons). The discriminatory power of a multivariable model for prediction of 3-year mortality was significantly improved after the inclusion of EuroSCORE (adjusted area under the receiver operating characteristic (ROC) curve = 0.779, 95% confidence interval 0.747 to 0.810, P = 0.008), but not after the inclusion of SxScore, SS II, or GRC.

Conclusions

In patients undergoing DES implantation for uLMCA disease, all evaluated risk scores were able to stratify the mortality risk at long-term follow-up. EuroSCORE was the only risk score that significantly improved the discriminatory power of a multivariable model to predict long-term mortality. © 2016 Wiley Periodicals, Inc.

REFERENCES

1 Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, et al. The SYNTAX Score: An angiographic tool grading the complexity of coronary artery disease. EuroIntervention 2005; 1: 219–227.
PubMed Google Scholar
2 Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014; 35: 2541–2619.
10.1093/eurheartj/ehu278
PubMed Web of Science® Google Scholar
3 Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 2011; 58: e44–e122.
10.1016/j.jacc.2011.08.007
PubMed Web of Science® Google Scholar
4 Valgimigli M, Serruys PW, Tsuchida K, Vaina S, Morel MA, et al. Cyphering the complexity of coronary artery disease using the syntax score to predict clinical outcome in patients with three-vessel lumen obstruction undergoing percutaneous coronary intervention. Am J Cardiol 2007; 99: 1072–1081.
10.1016/j.amjcard.2006.11.062
PubMed Web of Science® Google Scholar
5 Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009; 360: 961–972.
10.1056/NEJMoa0804626
CAS PubMed Web of Science® Google Scholar
6 Wykrzykowska JJ, Garg S, Girasis C, de Vries T, Morel MA, et al. Value of the SYNTAX score for risk assessment in the all-comers population of the randomized multicenter LEADERS (Limus Eluted from A Durable versus ERodable Stent coating) trial. J Am Coll Cardiol 2010; 56: 272–277.
10.1016/j.jacc.2010.03.044
PubMed Web of Science® Google Scholar
7 Garg S, Sarno G, Girasis C, Vranckx P, de Vries T, et al. A patient-level pooled analysis assessing the impact of the SYNTAX (synergy between percutaneous coronary intervention with taxus and cardiac surgery) score on 1-year clinical outcomes in 6,508 patients enrolled in contemporary coronary stent trials. JACC Cardiovasc Interv 2011; 4: 645–653.
10.1016/j.jcin.2011.02.018
PubMed Web of Science® Google Scholar
8 Palmerini T, Genereux P, Caixeta A, Cristea E, Lansky A, et al. Prognostic value of the SYNTAX score in patients with acute coronary syndromes undergoing percutaneous coronary intervention: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) trial. J Am Coll Cardiol 2011; 57: 2389–2397.
10.1016/j.jacc.2011.02.032
PubMed Web of Science® Google Scholar
9 Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999; 16: 9–13.
10.1016/S1010-7940(99)00134-7
CAS PubMed Web of Science® Google Scholar
10 Nilsson J, Algotsson L, Hoglund P, Luhrs C, Brandt J. Comparison of 19 pre-operative risk stratification models in open-heart surgery. Eur Heart J 2006; 27: 867–874.
10.1093/eurheartj/ehi720
PubMed Web of Science® Google Scholar
11 Romagnoli E, Burzotta F, Trani C, Siviglia M, Biondi-Zoccai GG, et al. EuroSCORE as predictor of in-hospital mortality after percutaneous coronary intervention. Heart 2009; 95: 43–48.
10.1136/hrt.2007.134114
CAS PubMed Web of Science® Google Scholar
12 Kim YH, Ahn JM, Park DW, Lee BK, Lee CW, et al. EuroSCORE as a predictor of death and myocardial infarction after unprotected left main coronary stenting. Am J Cardiol 2006; 98: 1567–1570.
10.1016/j.amjcard.2006.07.031
PubMed Web of Science® Google Scholar
13 Applegate RJ. Toward better stratification of patients with left main disease: Value of clinical and angiographic-derived risk scores. JACC Cardiovasc Interv 2011; 4: 298–299.
10.1016/j.jcin.2010.12.003
PubMed Web of Science® Google Scholar
14 Garg S, Sarno G, Garcia-Garcia HM, Girasis C, Wykrzykowska J, Dawkins KD, Serruys PW, Investigators a-I. A new tool for the risk stratification of patients with complex coronary artery disease: The Clinical SYNTAX Score. Circ Cardiovasc Interv 2010; 3: 317–326.
10.1161/CIRCINTERVENTIONS.109.914051
PubMed Web of Science® Google Scholar
15 Farooq V, Vergouwe Y, Raber L, Vranckx P, Garcia-Garcia H, et al. Combined anatomical and clinical factors for the long-term risk stratification of patients undergoing percutaneous coronary intervention: the Logistic Clinical SYNTAX score. Eur Heart J 2012; 33: 3098–3104.
10.1093/eurheartj/ehs295
PubMed Web of Science® Google Scholar
16 Farooq V, Vergouwe Y, Genereux P, Bourantas CV, Palmerini T, et al. Prediction of 1-year mortality in patients with acute coronary syndromes undergoing percutaneous coronary intervention: validation of the logistic clinical SYNTAX (Synergy Between Percutaneous Coronary Interventions With Taxus and Cardiac Surgery) score. JACC Cardiovasc Interv 2013; 6: 737–745.
10.1016/j.jcin.2013.04.004
PubMed Web of Science® Google Scholar
17 Capodanno D, Miano M, Cincotta G, Caggegi A, Ruperto C, Bucalo R, Sanfilippo A, Capranzano P, Tamburino C. EuroSCORE refines the predictive ability of SYNTAX score in patients undergoing left main percutaneous coronary intervention. Am Heart J 2010; 159: 103–109.
10.1016/j.ahj.2009.10.021
PubMed Web of Science® Google Scholar
18 Serruys PW, Farooq V, Vranckx P, Girasis C, Brugaletta S, et al. A global risk approach to identify patients with left main or 3-vessel disease who could safely and efficaciously be treated with percutaneous coronary intervention: The SYNTAX Trial at 3 years. JACC Cardiovasc Interv 2012; 5: 606–617.
10.1016/j.jcin.2012.03.016
PubMed Web of Science® Google Scholar
19 Farooq V, van Klaveren D, Steyerberg EW, Meliga E, Vergouwe Y, et al. Anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention for individual patients: Development and validation of SYNTAX score II. Lancet 2013; 381: 639–650.
10.1016/S0140-6736(13)60108-7
PubMed Web of Science® Google Scholar
20 Chieffo A, Meliga E, Latib A, Park SJ, Onuma Y, et al. Drug-eluting stent for left main coronary artery disease. The DELTA registry: A multicenter registry evaluating percutaneous coronary intervention versus coronary artery bypass grafting for left main treatment. JACC Cardiovasc Interv 2012; 5: 718–727.
10.1016/j.jcin.2012.03.022
PubMed Web of Science® Google Scholar
21 Campos CM, van Klaveren D, Iqbal J, Onuma Y, Zhang YJ, et al. Predictive performance of SYNTAX score II in patients with left main and multivessel coronary artery disease-analysis of CREDO-Kyoto registry. Circ J 2014; 78: 1942–1949.
10.1253/circj.CJ-14-0204
PubMed Web of Science® Google Scholar
22 Mehilli J, Kastrati A, Byrne RA, Bruskina O, Iijima R, et al. Paclitaxel- versus sirolimus-eluting stents for unprotected left main coronary artery disease. J Am Coll Cardiol 2009; 53: 1760–1768.
10.1016/j.jacc.2009.01.035
PubMed Web of Science® Google Scholar
23 Mehilli J, Richardt G, Valgimigli M, Schulz S, Singh A, et al. Zotarolimus- versus everolimus-eluting stents for unprotected left main coronary artery disease. J Am Coll Cardiol 2013; 62: 2075–2082.
10.1016/j.jacc.2013.07.044
CAS PubMed Web of Science® Google Scholar
24 Pencina MJ, D'Agostino RB Sr, D'Agostino RB Jr, Vasan RS. Evaluating the added predictive ability of a new marker: From area under the ROC curve to reclassification and beyond. Stat Med 2008; 27: 157–172. discussion 207-212.
10.1002/sim.2929
PubMed Web of Science® Google Scholar
25 Mohr FW, Morice MC, Kappetein AP, Feldman TE, Stahle E, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet 2013; 381: 629–638.
10.1016/S0140-6736(13)60141-5
PubMed Web of Science® Google Scholar
26 Morice MC, Serruys PW, Kappetein AP, Feldman TE, Stahle E, et al. Five-year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the synergy between percutaneous coronary intervention with taxus and cardiac surgery trial. Circulation 2014; 129: 2388–2394.
10.1161/CIRCULATIONAHA.113.006689
PubMed Web of Science® Google Scholar
27 Shiomi H, Morimoto T, Hayano M, Furukawa Y, Nakagawa Y, et al. Comparison of long-term outcome after percutaneous coronary intervention versus coronary artery bypass grafting in patients with unprotected left main coronary artery disease (from the CREDO-Kyoto PCI/CABG Registry Cohort-2). Am J Cardiol 2012; 110: 924–932.
10.1016/j.amjcard.2012.05.022
PubMed Web of Science® Google Scholar
28 Capodanno D, Capranzano P, Di Salvo ME, Caggegi A, Tomasello D, et al. Usefulness of SYNTAX score to select patients with left main coronary artery disease to be treated with coronary artery bypass graft. JACC Cardiovasc Interv 2009; 2: 731–738.
10.1016/j.jcin.2009.06.003
PubMed Web of Science® Google Scholar
29 Park SJ, Kim YH, Park DW, Yun SC, Ahn JM, et al. Randomized trial of stents versus bypass surgery for left main coronary artery disease. N Engl J Med 2011; 364: 1718–1727.
10.1056/NEJMoa1100452
CAS PubMed Web of Science® Google Scholar
30 Kim YH, Park DW, Kim WJ, Lee JY, Yun SC, Kang SJ, Lee SW, Lee CW, Park SW, Park SJ. Validation of SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score for prediction of outcomes after unprotected left main coronary revascularization. JACC Cardiovasc Interv 2010; 3: 612–623.
10.1016/j.jcin.2010.04.004
Web of Science® Google Scholar
31 Capodanno D, Di Salvo ME, Cincotta G, Miano M, Tamburino C, Tamburino C. Usefulness of the SYNTAX score for predicting clinical outcome after percutaneous coronary intervention of unprotected left main coronary artery disease. Circ Cardiovasc Interv 2009; 2: 302–308.
10.1161/CIRCINTERVENTIONS.108.847137
PubMed Web of Science® Google Scholar
32 Chakravarty T, Buch MH, Naik H, White AJ, Doctor N, Schapira J, Mirocha JM, Fontana G, Forrester JS, Makkar R. Predictive accuracy of SYNTAX score for predicting long-term outcomes of unprotected left main coronary artery revascularization. Am J Cardiol 2011; 107: 360–366.
10.1016/j.amjcard.2010.09.029
PubMed Web of Science® Google Scholar
33 Jou YL, Lu TM, Chen YH, Sung SH, Wang KL, Huang SS, Lin WT, Chan WL, Lin SJ. Comparison of the predictive value of EuroSCORE, SYNTAX score, and clinical SYNTAX score for outcomes of patients undergoing percutaneous coronary intervention for unprotected left main coronary artery disease. Catheter Cardiovasc Interv 2012; 80: 222–230.
10.1002/ccd.23450
PubMed Web of Science® Google Scholar
34 Rodes-Cabau J, Deblois J, Bertrand OF, Mohammadi S, Courtis J, et al. Nonrandomized comparison of coronary artery bypass surgery and percutaneous coronary intervention for the treatment of unprotected left main coronary artery disease in octogenarians. Circulation 2008; 118: 2374–2381.
10.1161/CIRCULATIONAHA.107.727099
PubMed Web of Science® Google Scholar
35 Min SY, Park DW, Yun SC, Kim YH, Lee JY, et al. Major predictors of long-term clinical outcomes after coronary revascularization in patients with unprotected left main coronary disease: Analysis from the MAIN-COMPARE study. Circ Cardiovasc Interv 2010; 3: 127–133.
10.1161/CIRCINTERVENTIONS.109.890053
PubMed Web of Science® Google Scholar
36 Capodanno D, Caggegi A, Miano M, Cincotta G, Dipasqua F, et al. Global risk classification and clinical SYNTAX (synergy between percutaneous coronary intervention with TAXUS and cardiac surgery) score in patients undergoing percutaneous or surgical left main revascularization. JACC Cardiovasc Interv 2011; 4: 287–297.
10.1016/j.jcin.2010.10.013
PubMed Web of Science® Google Scholar
37 Xu B, Genereux P, Yang Y, Leon MB, Xu L, et al. Validation and comparison of the long-term prognostic capability of the SYNTAX score-II among 1,528 consecutive patients who underwent left main percutaneous coronary intervention. JACC Cardiovasc Interv 2014; 7: 1128–1137.
10.1016/j.jcin.2014.05.018
PubMed Web of Science® Google Scholar
38 Farkouh ME, Domanski M, Sleeper LA, Siami FS, Dangas G, et al. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med 2012; 367: 2375–2384.
10.1056/NEJMoa1211585
CAS PubMed Web of Science® Google Scholar
39 Genereux P, Palmerini T, Caixeta A, Cristea E, Mehran R, et al. SYNTAX score reproducibility and variability between interventional cardiologists, core laboratory technicians, and quantitative coronary measurements. Circ Cardiovasc Interv 2011; 4: 553–561.
10.1161/CIRCINTERVENTIONS.111.961862
PubMed Web of Science® Google Scholar
40 Campos CM, van Klaveren D, Farooq V, Simonton CA, Kappetein AP, Sabik JF III, Steyerberg EW, Stone GW, Serruys PW. On Behalf of the ETI. Long-term forecasting and comparison of mortality in the Evaluation of the Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial: prospective validation of the SYNTAX Score II. Eur Heart J 2015; 36: 1231–1241.
10.1093/eurheartj/ehu518
PubMed Web of Science® Google Scholar
41 Byrne RA, Kastrati A. Prognosis after revascularization for left main coronary artery disease: Insights from the crystal ball. Eur Heart J 2015; 36: 1212–1215.
10.1093/eurheartj/ehv062
PubMed Web of Science® Google Scholar

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Volume89, Issue1

January 2017

Pages 1-10

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Long-term prognostic value of risk scores after drug-eluting stent implantation for unprotected left main coronary artery: A pooled analysis of the ISAR-LEFT-MAIN and ISAR-LEFT-MAIN 2 randomized clinical trials

Abstract

Objectives

Background

Methods

Results

Conclusions

REFERENCES

Citing Literature

References

Information

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Long-term prognostic value of risk scores after drug-eluting stent implantation for unprotected left main coronary artery: A pooled analysis of the ISAR-LEFT-MAIN and ISAR-LEFT-MAIN 2 randomized clinical trials

Abstract

Objectives

Background

Methods

Results

Conclusions

REFERENCES

Citing Literature

References

Related

Information