Premium
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
Author(s) -
Xhepa Erion,
Tada Tomohisa,
Kufner Sebastian,
Ndrepepa Gjin,
Byrne Robert A.,
Kreutzer Johanna,
Ibrahim Tareq,
Tiroch Klaus,
Valgimigli Marco,
Tölg Ralf,
Cassese Salvatore,
Fusaro Massimiliano,
Schunkert Heribert,
Laugwitz Karl L.,
Mehilli Julinda,
Kastrati Adnan
Publication year - 2017
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26645
Subject(s) - medicine , cardiology , euroscore , randomized controlled trial , confidence interval , drug eluting stent , stent , coronary artery disease , myocardial infarction , percutaneous coronary intervention , surgery , artery
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.