Abstract
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. 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. 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. 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.
Published Version
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