title: Global risk score for choosing the best revascularization strategy in patients with unprotected left main stenosis.
abstract: BACKGROUND
  Coronary artery bypass graft (CABG) is recommended for patients with unprotected left main stenosis (ULMS). Percutaneous coronary intervention (PCI) is only recommended in specific anatomic conditions as in patients with low/mid SYNTAX score (SS). The aim of this study was to assess if the clinical and anatomic global risk classification (GRC) can enhance the indication of both revascularization therapies.
  
  
  METHODS
  A total of 407 patients with ULMS treated with CABG (n = 285) or PCI (n = 122) were prospectively collected. The decision to treat with CABG or PCI was dependent on patient and physician's choice. Patients with ST-elevation myocardial infarction, shock, or valve disease were excluded. Clinical follow-up was obtained at 3 years.
  
  
  RESULTS
  Patients with low GRC (n = 151) treated with CABG vs those with PCI had similar cardiac mortality (5.9% vs 0%, respectively; P=.17) and major adverse cardiac events (MACE; 18.5% vs 12.5%, respectively; P=.40). Patients classified as mid GRC (n = 175) had similar cardiac death (11.1% vs 10.3%; P=.85) and MACE rates (20.7% vs 22.4%; P=.92) with CABG or PCI, respectively. Patients with high GRC (n = 81) treated with CABG had numerically fewer cardiac deaths (16.3% vs 28.1%; P=.16) and lower MACE rates (24.5% vs 40.6%; P=.048) than with PCI. Statistical models using the GRC as a predictor of cardiac death showed better goodness-of-fit than the SS.
  
  
  CONCLUSIONS
  Patients with low/mid GRC have similar mid-term outcomes with either CABG or PCI; patients with high GRC seem to benefit from CABG. Although further investigations are required, GRC is a better predictor of outcomes than SS.
authors.affiliation: Department of Interventional Cardiology, Hospital Universitari de Bellvitge, c/ Feixa Llarga sn, L'Hospitalet de Llobregat, Spain. gomezjosep@hotmail.com.
authors.forename: Josep
authors.initials: J
authors.lastname: Gomez-Lara
authors.forename: Gerard
authors.initials: G
authors.lastname: Roura
authors.forename: Arnau
authors.initials: A
authors.lastname: Blasco-Lucas
authors.forename: Daniel
authors.initials: D
authors.lastname: Ortiz
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Sbraga
authors.forename: Rafael
authors.initials: R
authors.lastname: Romaguera
authors.forename: Jose-Luis
authors.initials: JL
authors.lastname: Ferreiro
authors.forename: Luis
authors.initials: L
authors.lastname: Teruel
authors.forename: Guillermo
authors.initials: G
authors.lastname: Sanchez-Elvira
authors.forename: Silvia
authors.initials: S
authors.lastname: Homs
authors.forename: Ana
authors.initials: A
authors.lastname: Marcano
authors.forename: Oriol
authors.initials: O
authors.lastname: Alegre
authors.forename: José
authors.initials: J
authors.lastname: González-Costello
authors.forename: Joan-Antoni
authors.initials: JA
authors.lastname: Gomez-Hospital
authors.forename: Carles
authors.initials: C
authors.lastname: Fontanillas
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D011859:Radiography; D012307:Risk Factors; D016896:Treatment Outcome