title: 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.
abstract: OBJECTIVE
  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.
authors: Deutsches Herzzentrum, Technische Universität München, Munich, Germany.
authors: Erion
authors: http://orcid.org/0000-0002-0728-2819
authors: E
authors: Xhepa
authors: Deutsches Herzzentrum, Technische Universität München, Munich, Germany.
authors: Tomohisa
authors: T
authors: Tada
authors: Deutsches Herzzentrum, Technische Universität München, Munich, Germany.
authors: Sebastian
authors: S
authors: Kufner
authors: Deutsches Herzzentrum, Technische Universität München, Munich, Germany.
authors: Gjin
authors: G
authors: Ndrepepa
authors: Deutsches Herzzentrum, Technische Universität München, Munich, Germany.
authors: Robert A
authors: RA
authors: Byrne
authors: Deutsches Herzzentrum, Technische Universität München, Munich, Germany.
authors: Johanna
authors: J
authors: Kreutzer
authors: Medizinische Klinik, Klinikum rechts der Isar, Technische Universität Muenchen, Munich, Germany.
authors: Tareq
authors: T
authors: Ibrahim
authors: Helios Clinic Wuppertal, Med. Klinik 3 - Kardiologie, Wuppertal, Germany.
authors: Klaus
authors: K
authors: Tiroch
authors: Thoraxcenter, Ba 587, Erasmus MC, Rotterdam, the Netherlands.
authors: Marco
authors: M
authors: Valgimigli
authors: Herzzentrum, Kardiologie, Segeberger Kliniken, Bad Segeberg, Germany.
authors: Ralf
authors: R
authors: Tölg
authors: Deutsches Herzzentrum, Technische Universität München, Munich, Germany.
authors: Salvatore
authors: S
authors: Cassese
authors: Deutsches Herzzentrum, Technische Universität München, Munich, Germany.
authors: Massimiliano
authors: M
authors: Fusaro
authors: Deutsches Herzzentrum, Technische Universität München, Munich, Germany.|DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich, Germany.
authors: Heribert
authors: H
authors: Schunkert
authors: Medizinische Klinik, Klinikum rechts der Isar, Technische Universität Muenchen, Munich, Germany.|DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich, Germany.
authors: Karl L
authors: KL
authors: Laugwitz
authors: DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich, Germany.|Klinikum der Universität München; Medizinische Klinik I, Munich, Germany.
authors: Julinda
authors: J
authors: Mehilli
authors: Deutsches Herzzentrum, Technische Universität München, Munich, Germany.|DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Munich, Germany.
authors: Adnan
authors: A
authors: Kastrati
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002317:Cardiovascular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D003661:Decision Support Techniques; D016002:Discriminant Analysis; D054855:Drug-Eluting Stents; D000068338:Everolimus / Q000008:administration & dosage; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017239:Paclitaxel / Q000008:administration & dosage; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012372:ROC Curve; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D000068338:Everolimus; C489443:zotarolimus; D017239:Paclitaxel; D020123:Sirolimus
keywords: clinical trials; drug-eluting stent; left main coronary disease; percutaneous coronary intervention; risk stratification