[Clinical predictors of left main coronary artery disease in high-risk patients with a first episode of non-ST-segment elevation acute coronary syndrome].
OBJECTIVE
Risk stratification in non-ST-elevation acute coronary syndrome makes use of clinical variables that can identify patients at an increased risk of complications. Our objective was to identify clinical variables that predict significant stenosis (i.e., >50%) of the left main coronary artery in high-risk patients who have had a first episode of non-ST-elevation acute coronary syndrome but who do not have a history of coronary artery disease.


METHODS
The study included 102 high-risk patients with no history of coronary artery disease who were admitted because of non-ST-elevation acute coronary syndrome. All underwent coronary angiography. Patients were divided into two groups: those with significant left main coronary artery stenosis (n=14) and those without (n=88).


RESULTS
Univariate analysis showed that the variables significantly associated with left main coronary artery stenosis were age >65 years (57.1% vs 15.9%, P=.002), diabetes mellitus (71.4% vs 33.0%, P=.006), chronic renal failure (28.6% vs 5.7%, P=.019), left heart failure (71.4% vs 6.8%, P< .0001), cardiogenic shock (21.4% vs 1.1%, P=.008), and a low left ventricular ejection fraction at admission (49.9% [14.7%] vs 58.8% [9.9%], P=.044). In the multivariate analysis, the only significant independent predictor of left main coronary artery disease was left heart failure.


CONCLUSIONS
The presence of left heart failure at initial assessment of high-risk patients with non-ST-elevation acute coronary syndrome but without a history of coronary artery disease could be a useful predictor of significant left main coronary artery disease.
Claver
Eduard
E
Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
Curós
Antoni
A
López-Ayerbe
Jordi
J
Serra
Jordi
J
Mauri
Josepa
J
Fernández-Nofrerias
Eduard
E
Rodríguez-Leor
Oriol
O
Bernal
Eva
E
Valle
Vicente
V
D000208:Acute Disease; D000789:Angina, Unstable / Q000150:complications*; D023921:Coronary Stenosis / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D011379:Prognosis; D012307:Risk Factors; D013577:Syndrome