The prognostic importance of nonsignificant left main coronary artery disease in patients undergoing percutaneous coronary intervention.
OBJECTIVE
The purpose of this research was to study the association between nonsignificant (<50%) left main coronary artery disease (LMCAD) and short- and long-term survival in patients undergoing percutaneous coronary intervention (PCI).


BACKGROUND
The prognostic importance of nonsignificant LMCAD is unknown; however, the co-existence of nonsignificant LMCAD may influence revascularization decisions.


METHODS
We analyzed mortality and repeat catheterization rates of 11,855 patients in a prospective cardiac registry database who underwent single-vessel or multivessel PCI from January 1996 through December 2001. Of this cohort, 11.7% (n = 1,385) had nonsignificant (<50%) LMCAD. Outcomes were compared with those without LMCAD. A secondary analysis was performed on a larger cohort of 34,586 patients undergoing cardiac catheterization, irrespective of mode of revascularization therapy.


RESULTS
Patients with nonsignificant LMCAD had more co-morbidities, and a significantly higher crude mortality rate at 1 year compared with those without LMCAD (4.4% vs. 3.4%; p = 0.05). The 7-year crude mortality hazard ratio (HR) of PCI patients with <50% LMCAD versus those with no LMCAD was 1.18 (95% confidence interval [CI] 0.94 to 1.46). After risk adjustment for differences in baseline clinical profile, however, the HR decreased to 0.98 (95% CI 0.79 to 1.23). Repeat catheterization rates at 1 year did not differ between groups. The secondary analysis in all patients with nonsignificant LMCAD showed an adjusted HR of 1.03 (95% CI 0.94 to 1.14).


CONCLUSIONS
Patients undergoing single-vessel or multivessel PCI who have <50% LMCAD have a nonsignificantly increased 18% relative risk for mortality compared with those without detectable LMCAD that appears to be related to these patients' higher incidence of co-morbidities rather than the left main stenosis itself.
Gyenes
Gabor
G
University of Alberta, Edmonton, Alberta, Canada. ggyenes@cha.ab.ca
Shrive
Fiona M
FM
Graham
Michelle M
MM
Ghali
William A
WA
Knudtson
Merrill L
ML
D000368:Aged; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D023921:Coronary Stenosis / Q000453:epidemiology / Q000401:mortality / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D019233:Retreatment; D018570:Risk Assessment; D015607:Stents