Abstract
Introduction and Objectives: The natural history of patients with left main coronary artery disease (LMCAD) is largely unknown. Our objective was to analyse the predictors of long-term mortality in these patients, both those that have had surgery and those that have not undergone surgery for various reasons, in a cohort treated at a university hospital. Methods: The study included patients with significant LMCAD diagnosed through consecutive coronary angiograms from 2001 to 2009. Clinical variables, the reasons for cardiac catheterisation, therapeutic decisions and clinical evolution in long-term follow-up were analysed. Results: Of the 163 patients included in the analysis, a total of 109 (66.9%) underwent revascularisation, while the remaining 54 (33.1%) received other medical treatment. We analysed the clinical events that took place with a mean follow-up period of 54 months (IQR: 25-95). The non-revascularised group had a lower survival rate than the revascularised group in unadjusted analysis (logrank test 0.005). Age (OR 1.04, CI 1.02-1.07, p = 0.001), ventricular dysfunction (OR 2.87, CI95% 1.71-4.81, p 0.0001), clinical instability (OR 2.11, CI95% 1.08 to 4.13, p = 0.028) and above 70% severity of LMCAD (OR 1.78, CI 1.09 to 2.91, p = 0.021) were independent predictors of mortality for the entire cohort, but revascularisation was not. Conclusions: Revascularisation is associated with improved survival in patients with LMCAD, but only age, ventricular dysfunction, clinical instability and the severity of the lesion are independent predictors of long-term mortality in the unselected population.
Highlights
Introduction and ObjectivesThe natural history of patients with left main coronary artery disease (LMCAD) is largely unknown
Of the 4851 consecutive coronary angiograms conducted from 2001 to 2009, we found 211 new diagnoses of LMCAD, representing 4.3%
The revascularised patients were significantly younger and included a higher proportion of men and current smokers, less history of myocardial infarction and heart failure, and a greater proportion of severe LMCAD, with a lower proportion of three-vessel disease compared to patients who were not revascularised
Summary
Introduction and ObjectivesThe natural history of patients with left main coronary artery disease (LMCAD) is largely unknown. Conclusions: Revascularisation is associated with improved survival in patients with LMCAD, but only age, ventricular dysfunction, clinical instability and the severity of the lesion are independent predictors of long-term mortality in the unselected population. Complex anatomy or contraindication for dual antiplatelet therapy as well as other factors may preclude treating patients by means of this method, leaving medical treatment as the only option. This means that in daily clinical practice, a certain percentage of patients with LMCAD do not undergo revascularisation and can only choose medical treatment [6] [7]. The real benefit of revascularisation compared to medical therapy must be understood, while taking into account that the clinical profile of these two groups of patients is usually different
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