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

Xhepa E, Tada T, Kufner S, Ndrepepa G, Byrne RA, Kreutzer J, Ibrahim T, Tiroch K, Valgimigli M, Toelg R, Cassese S, Fusaro M, Schunkert H, Laugwitz KL, Mehilli J, Kastrati A (2017)

Publication Type: Journal article

Publication year: 2017

Journal

Catheterization and Cardiovascular Interventions Wiley-Blackwell

Book Volume: 89

Pages Range: 1-10

Journal Issue: 1

DOI: 10.1002/ccd.26645

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.

Involved external institutions

Technische Universität München (TUM) DE Germany (DE) HELIOS Kliniken DE Germany (DE) Erasmus University Medical Center (MC) NL Netherlands (NL) Segeberger Kliniken DE Germany (DE) Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK e.V.) DE Germany (DE)

How to cite

APA:

Xhepa, E., Tada, T., Kufner, S., Ndrepepa, G., Byrne, R.A., Kreutzer, J.,... Kastrati, A. (2017). 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. Catheterization and Cardiovascular Interventions, 89(1), 1-10. https://doi.org/10.1002/ccd.26645

MLA:

Xhepa, Erion, et al. "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." Catheterization and Cardiovascular Interventions 89.1 (2017): 1-10.

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