Left coronary ostial stenosis: Comparison with left main coronary artery stenosis

Abstract

We compared 147 consecutive patients who had left coronary ostial stenosis with 254 consecutive patients who had left main coronary artery stenosis treated with coronary artery bypass grafting. Mean age for the left main group was 61.6 years versus 59.7 years for the left ostial group ( p = not significant [NS]). In the left ostial group, 43.5% were female and in the left main group, 12% ( p < 0.005). Prior myocardial infarction had occurred in 53% of patients with left main stenosis and 36% of patients with left ostial stenosis ( p < 0.005). There were 2.45 ± 1.00 diseased vessels in the left main group and 1.96 ± 1.09 in the left ostial group ( p < 0.0005). Seven (3%) of the patients with left main stenosis had no associated coronary disease (greater than 50%) versus 24 (16%) of the left ostial group ( p < 0.005). The degree of left main stenosis was 90% or more in 28.3% of patients versus 42.8% with equivalent ostial narrowing ( p < 0.01). Left ventricular function was better in the left ostial group than in the left main group (1.61 ± 0.93 versus 2.02 ± 1.11, respectively; p < 0.0005). One-month mortality was 10 patients (3.9%) in the left main group and 8 (5.4%) in the left ostial group ( p = NS). Perioperative infarction occurred in 8.6% of patients with left main stenosis and 4.7% of patients with left ostial stenosis ( p = NS). Mean follow-up was 6.1 years for the left main group and 5.4 years for the left ostial group. Cumulative survival for the left main group and the left ostial group, respectively, was as follows: 1 year, 94.6% and 91.8% ( p = NS); 5 years, 85.6% and 83.1% ( p = NS); and 10 years, 74.2% and 66.4% ( p = NS). Angina recurred in 38.9% of the patients with left main stenosis and 23.0% of patients with left ostial stenosis ( p < 0.005). Late myocardial infarction occurred in 9.0% of the left main group and 3.5% of the left ostial group ( p < 0.05). Although differing in gender distribution and the prevalence of associated coronary artery disease and its sequelae, the survival curves are similar for patients with left coronary ostial stenosis and those with left main coronary stenosis.