title: A "no-option" left main PCI registry: outcomes and predictors of in hospital mortality-utility of the logistic EuroSCORE.
abstract: BACKGROUND
  Although high-risk left main PCI populations have been previously described, there is little data describing outcomes and the role of the logistic EuroSCORE in surgical turndown cohorts or patients in extremis due to acute infarction or cardiogenic shock from left main ischemia.
  
  
  METHODS
  Consecutive patients with unprotected LM PCI who were surgical turndowns or in extremis were included in this retrospective cohort from 2004 to 2009 at two tertiary centers. Predictors of in-hospital mortality were identified utilizing routine and stepwise logistic regression.
  
  
  RESULTS
  There were a total of 56 patients with mean age of 69 (±13). There were 23 (41%) patients with cardiogenic shock. The mean logistic EuroSCORE was 23.5% ± 21%. In-hospital death occurred in 12 (21%) patients, largely restricted to the shock subgroup (11/12). Univariate predictors of mortality included peak CK levels (P = 0.01), transfusion (P = 0.01), cardiogenic shock (P < 0.002), male gender (P = 0.027), and logistic EuroSCORE (P = 0.01). Stepwise logistic regression yielded logistic EuroSCORE (P = 0.04, OR: 1.25 (95% CI: 1.01-1.56) for every 5% increase) and peak CK level (P = 0.001, OR: 1.23 (95% CI: 1.09-1.40) for every 500 unit increase) as independent predictors of in-hospital mortality. The AUC ROC for logistic EuroSCORE was 0.73; and for logistic EuroSCORE plus peak CK level was 0.89.
  
  
  CONCLUSIONS
  PCI appears to be a reasonable option in the high risk "no option" LM population, with the logistic EuroSCORE and peak CK levels being independent predictors of in-hospital mortality. Specifically, the logistic EuroSCORE and peak CK level combined discriminate in-hospital mortality with a high degree of certainty.
authors.affiliation: Department of Cardiology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Nader
authors.initials: N
authors.lastname: Elmayergi
authors.forename: Thang
authors.initials: T
authors.lastname: Nguyen
authors.forename: Brett
authors.initials: B
authors.lastname: Hiebert
authors.forename: Roger K
authors.initials: RK
authors.lastname: Philipp
authors.forename: Davinder S
authors.initials: DS
authors.lastname: Jassal
authors.forename: James W
authors.initials: JW
authors.lastname: Tam
authors.forename: Farrukh
authors.initials: F
authors.lastname: Hussain
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003402:Creatine Kinase / Q000097:blood; D003661:Decision Support Techniques; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality*; D012372:ROC Curve; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000401:mortality / Q000628:therapy; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D003402:Creatine Kinase