This study aimed to identify the independent predictors of death and myocardial infarction (MI) after unprotected left main coronary artery stenting with bare metal (n = 148) or sirolimus-eluting (n = 176) stents between January 2000 and March 2005. To identify independent predictors of death and nonfatal MI, all available parameters were evaluated. Systemic surgical risk stratification systems such as the EuroSCORE and Parsonnet score were included in the analysis. Clinical information at 9 months was available in 98% of patients (median follow-up 26.3 months). During this period, death/MI occurred in 42 patients (13%). Of the 5 deaths, 4 were related to cardiac and 1 to noncardiac causes. By multivariate Cox regression analysis, a high EuroSCORE (> or =6; hazard ratio 3.4, 95% confidence interval 1.2 to 9.6, p = 0.023), number of stents used (hazard ratio 1.8, 95% confidence interval 1.0 to 3.1, p = 0.042), and treatment with a glycoprotein IIb/IIIa inhibitor (hazard ratio 8.6, 95% confidence interval 2.7 to 27.4, p <0.001) were independent predictors of death/MI. Areas under the receiver-operating characteristic curve of EuroSCORE and number of stents were 0.61 (95% confidence interval 0.52 to 0.70, p = 0.023) and 0.61 (95% confidence interval 0.51 to 0.70, p = 0.028), respectively. In conclusion, high surgical risk estimated by systemic risk stratification of the EuroSCORE appears to be associated with unfavorable outcomes of unprotected left main coronary artery stenting.