TITLE:
Long-Term Prognostic Factors in Patients with Significant Left Main Coronary Artery Disease
AUTHORS:
Mercedes Camprubí, Ramón de Castro, Mohsen Mohandes, Jordi Guarinos, Miriam Garcia-Bermúdez, Alfredo Bardají
KEYWORDS:
Left Main Coronary Artery Disease; Surgical Revascularisation; Percutaneous Coronary Intervention
JOURNAL NAME:
International Journal of Clinical Medicine,
Vol.5 No.5,
March
14,
2014
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.