Author + information
- S1936879815020993-9e31b7ab4ff6fa05e5ef7c3a49e03c9fRajan L. Shah,
- S1936879815020993-a5a908cfb86eb3fce07c78e69c20ba79Meena Narayanan,
- S1936879815020993-8a0d83c4defd40a95174b9636fbf703aAnisha Rastogi,
- S1936879815020993-36dc6d39f153d8b7694abff78d43d9d2David Shavelle,
- S1936879815020993-d54a419011ec9134c195704db787dd08Ray Matthews,
- S1936879815020993-6f602475989092ce09105667b5679d08Leonardo Clavijo,
- S1936879815020993-8ae72cba076ad46bb44f6f0885c87d5cHan Tun and
- S1936879815020993-4ad91e595990bf1dda8fcdba1746f861Anilkumar Mehra
In patients evaluated for Coronary Artery Bypass Grafting (CABG), established risk scores are used to stratify patients and determine surgical candidacy. Evidence demonstrates that comorbidities also influence outcomes in patients undergoing high-risk percutaneous coronary intervention (HRPCI) and recent studies have criticized anatomic-based scores, such as the SYNTAX score (SXS), due to the absence of clinical factors. The aim of our study is to compare established and novel risk scores, including clinical and anatomic-weighted scores, and investigate their ability to predict mortality in surgically rejected patients undergoing HRPCI for unprotected left main coronary disease (ULMD).
A retrospective study was performed involving 71 patients with ULMD who were denied CABG and subsequently underwent HRPCI at Keck School of Medicine (4/2008-6/2014). Patients were stratified based on STS score: >10 (n=18) v. <10 (n=53); euroSCORE II (ErS): >15 (n=13) v. <15 (n=58); anatomic SXS: >33 (n=20) v. <33 (n=51); Global Risk Score (GRS): high risk [defined as ErS >6 AND SXS >33] (n=10) v. non-high risk (n=61); Clinical SXS: >27.5 (n=54) v. <27.5 (n=17).
71 patients underwent HRPCI of ULMD after being declined for surgical revascularization (mean age 69.6 +/- 13 years; 63% male). Mean STS score was 8.46; mean ErS was 10.43; mean anatomic SXS was 24.56; mean Clinical SXS was 89.45. In-hospital mortality was 7%; 30-day mortality was 7%; 1-year mortality was 22%; total mortality was 37%. Compared to those with low STS, patients with STS scores >10 had significantly higher mortality in-hospital (27.7% v. 0%, p=0.01), at 30 days (27.7% v. 0%, p=0.01), and at 1-year follow-up (55.6% v. 11.3%, p=0.02). Compared to those with low ErS, patients with ErS >15 had significantly higher mortality in-hospital (38.5% v. 0%, p=0.01), at 30 days (38.5% v. 0%, p=0.01), and at 1-year follow-up (53.9% v. 15.5%, p=0.03). Compared to those with lower GRS, patients with high risk GRS had significantly higher mortality in-hospital (30% v. 3.3%, p=0.02), at 30 days (30% v. 3.3%, p=0.02), and at 1-year follow-up (50% v. 18%, p=0.05). However, there was no significant difference for in-hospital, 30-day, or 1-year mortality in patients stratified by anatomical or Clinical SXS.
In patients with ULMD rejected for CABG and undergoing HRPCI, clinical-weighted scores are useful predictors of short-term and late mortality; the anatomic and even Clinical SXS appear biased by anatomic data and are not effective predictors of mortality in this population.