APEX-LM Calculator

Appropriateness of Percutaneous EXpertise for Left Main

A proposed clinical decision-support tool integrating anatomical complexity, clinical risk factors, and procedural feasibility to guide Heart Team discussions on optimal revascularization strategy.

Research Tool: This scoring system is proposed based on evidence synthesis and has not been prospectively validated. Clinical decisions should always involve Heart Team discussion.

Low (≤22)
+2
Intermediate (23–32)
0
High (≥33)
-3
Ostial or Mid-Shaft
+2
Distal Bifurcation (Simple)
0
Distal Bifurcation (Complex)
-2
Isolated LM or LM + 1-Vessel Disease
+1
LM + 2-Vessel Disease
0
LM + 3-Vessel Disease (True 4VD)
-2

Total APEX-LM Score

0/9 variables
0pts
CABGEquipoiseIVI-PCI
Anatomical Factors0
Clinical Factors0
Procedural Factors0

Clinical Equipoise

Both strategies are viable. Decision should be driven by Heart Team consensus, local operator expertise (surgical vs. interventional volume), and patient preference regarding repeat revascularization risk vs. upfront surgical recovery.

Complete all 9 variables for a definitive recommendation.

Score Interpretation Guide

+3 to +13:Strongly Favor IVI-Guided PCI
-2 to +2:Clinical Equipoise (Heart Team Decision)
-3 to -16:Strongly Favor CABG