Can patients with left main coronary artery disease wait for myocardial revascularization surgery?
OBJECTIVE
To assess the occurrence of cardiac events in patients diagnosed with left main coronary artery disease on diagnostic cardiac catheterization and waiting for myocardial revascularization surgery.


METHODS
All patients diagnosed with left main coronary artery disease (stenosis > or = 50%) consecutively identified on diagnostic cardiac catheterization during an 8-month period were selected for the study. The group comprised 56 patients (40 males and 16 females) with a mean age of 61 10 years. The cardiac events included death, nonfatal acute myocardial infarction, acute left ventricular failure, unstable angina, and emergency surgery.


RESULTS
While waiting for surgery, patients experienced the following cardiac events: 7 acute myocardial infarctions and 1 death. All events occurred within the first 60 days after the diagnostic cardiac catheterization. More patients, whose indication for diagnostic cardiac catheterization was unstable angina, experienced events as compared with those with other indications [p=0.03, relative risk (RR) = 5.25, 95% confidence interval = 1.47 - 18.7]. In the multivariate analysis of logistic regression, unstable angina was also the only factor that independently contributed to a greater number of events (p = 0.02, OR = 8.43, 95% CI =1.37 - 51.7).


CONCLUSIONS
Unstable angina in patients with left main coronary artery disease acts as a high risk factor for cardiac events, emergency surgery being recommended in these cases.
da Rocha
Antônio Sérgio Cordeiro
AS
Instituto Nacional de Cardiologia Laranjeiras, Minist rio da Sa de, Rio de Janeiro, RJ, Brazil. asrocha@cardiol.br
da Silva
Paulo Roberto Dutra
PR
D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000150:complications; D006328:Cardiac Catheterization; D023921:Coronary Stenosis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D009204:Myocardial Revascularization; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors