Related Experiment Video
Updated: May 5, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Global risk score for choosing the best revascularization strategy in patients with unprotected left main stenosis
Josep Gomez-Lara1, Gerard Roura, Arnau Blasco-Lucas
1Department of Interventional Cardiology, Hospital Universitari de Bellvitge, c/ Feixa Llarga sn, L'Hospitalet de Llobregat, Spain. gomezjosep@hotmail.com.
Insights
The Global Risk Classification (GRC) helps guide treatment for unprotected left main stenosis (ULMS). Low/mid GRC patients have similar outcomes with bypass surgery (CABG) or stenting (PCI), while high GRC patients benefit from CABG.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Unprotected left main stenosis (ULMS) typically warrants coronary artery bypass graft (CABG).
- Percutaneous coronary intervention (PCI) is reserved for select cases, often based on low/mid SYNTAX score (SS).
- Current risk stratification may not fully optimize treatment decisions for ULMS patients.
Purpose of the Study:
- To evaluate the Global Risk Classification (GRC) as a tool to enhance treatment indications for ULMS.
- To compare outcomes of CABG versus PCI in ULMS patients stratified by GRC.
- To assess the predictive performance of GRC against the SYNTAX score (SS) for cardiac events.
Main Methods:
- A prospective cohort of 407 ULMS patients treated with CABG (n=285) or PCI (n=122) was analyzed.
- Patients were stratified into low, mid, and high GRC groups.
- Clinical outcomes, including cardiac mortality and major adverse cardiac events (MACE), were assessed at 3-year follow-up.
Main Results:
- Low/mid GRC groups showed no significant difference in cardiac mortality or MACE between CABG and PCI.
- High GRC patients treated with CABG exhibited numerically lower cardiac deaths and significantly lower MACE compared to PCI.
- GRC demonstrated a better goodness-of-fit than SS in predicting cardiac death.
Conclusions:
- GRC aids in selecting optimal revascularization strategy for ULMS patients.
- Low/mid GRC patients achieve similar mid-term outcomes with either CABG or PCI.
- High GRC patients appear to benefit more from CABG, suggesting GRC's superior predictive value over SS.
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.
Conclusion:
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.
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:30Acute Coronary Syndrome I: Introduction
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
01:26Atherosclerosis III: Management
01:12Relative Risk