Inflammatory biomarkers for prediction of outcomes after unprotected left main coronary intervention.

Unprotected left main coronary artery (ULMCA) lesions are candidates for coronary artery bypass surgery because of the high risk of serious adverse periprocedural events and long-term complications associated with percutaneous coronary intervention (PCI). Although coronary stents have improved initial outcomes of PCI with coronary balloon angioplasty, the outcomes of coronary stenting in ULMCA remain mixed, even with the use of drug-eluting stents.1–7 Periprocedural safety and long-term outcomes are excellent in patients at low risk1–7; however, long-term mortality associated with ULMCA stenting is 25% in patients at high risk.3 These variations have resulted in studies that evaluated factors influencing ULMCA stenting outcomes. The recent Unprotected Left Main Trunk Investigation Multicenter Assessment (ULTIMA) registry report involved 279 patients, 46% of whom were deemed inoperable or at high surgical risk.3 For the latter patients, the in-hospital mortality rate was 14%, whereas the 1-year incidence rates were 24.2% for all-cause mortality, 20.2% for cardiac mortality, and 9.8% for myocardial infarction (MI). In that study, decreasing left ventricular function ( 30%) was inversely related to events. In contrast, for the low-risk ULTIMA registry subset of 89 patients, the 1-year actuarial death rate was 3.4% and the MI rate was 2.3%. Likewise, we reported that the procedural success rate was 99.1%, with no incidence of cardiac death or MI during the follow-up period in selected patients with normal left ventricular function and who were good surgical candidates.1 The risk factors analyzed by these studies, such as low left ventricular ejection fraction, older age, and comorbidity, have been useful in selecting candidates for elective ULMCA stenting. The impact of these patient and angiographic risk factors on long-term outcomes is not always consistent, however. Moreover, these risk factors are not amendable before and after PCI. Given these facts, identifying systemic biomarkers that may predict ULMCA intervention outcomes would be valuable in selecting appropriate candidates and for accurately predicting prognosis. Article p 2332