Clinical predictors of left main coronary artery disease in patients with NSTE-ACS

Abstract

Risk stratification in non-ST-elevation acute coronary syndrome makes use of clinical variables that can identify patients at an increased risk of complications. Our objective was to identify clinical variables that predict significant stenosis of the left main coronary artery in NSTE-ACS. The study included 296 patients who were admitted because of non-ST-elevation acute coronary syndrome. All underwent coronary angiography. Patients were divided into 2 groups: those with significant left main coronary artery stenosis ( n = 21) and those without ( n = 275). Univariate analysis showed that the variables significantly associated with left main coronary artery stenosis were age ≥ 70 years (12.1% vs. 4.9%; P = 0.04), male sex (10.5% vs. 2.4%; P = 0.01), recurrent angina (20.3% vs. 3.8%; P < 0.0001), heart rate ≥ 100 (20.8% vs. 5.9%; P = 0.019) left heart failure (23.1% vs. 6.4%; P = 0.05), and an ankle-brachial index < 0.9 (19.4% vs. 5.4%; P = 0.007). In the multivariate analysis, the independent clinical predictors of left main coronary artery disease were recurrent angina, heart rate ≥ 100 bpm and left heart failure at initial assessment. The presence of recurrent angina, heart rate ≥ 100 and left heart failure at initial assessment patients with non-ST-elevation acute coronary syndrome could be a useful predictor of significant left main coronary artery disease.