Staudacher DL, Schmitt C, Zirlik A, et al. - Researchers undertook this retrospective single-center all-comers registry study to determine the factors predictive of survival in unstable patients, with high SYNTAX-1-score, undergoing percutaneous coronary intervention (PCI) of unprotected left main coronary artery (ULMCA). An acute condition, including acute myocardial infarction, cardiogenic shock, or need for mechanical support, was more commonly seen in patients in the high-SYNTAX-1-group (score > 32) vs low-SYNTAX-2-group (score ≤ 32). Presentation in acute conditions with high SYNTAX-1-score was seen in the majority of patients undergoing ULMCA-PCI in this study and this was held responsible for the underrepresentation of this cohort in clinical trials. The acute condition and the EuroScore II were identified as the best predictors of prognosis. Using clinical condition over the anatomical SYNTAX-1-score as a guide to therapy in unstable patients was recommended.