title: Prevalence and non-invasive predictors of left main or three-vessel coronary disease: evidence from a collaborative international meta-analysis including 22 740 patients.
abstract: BACKGROUND
  Left main disease (LMD) and three-vessel disease (3VD) have important prognostic value in patients with coronary artery disease. However, uncertainties still exist about their prevalence and predictors in patients with acute coronary syndrome (ACS) and also in patients with stable coronary disease. Thus the aim of this study was to perform an international collaborative systematic review and meta-analysis to appraise the prevalence and predictors of LMD and 3VD.
  
  
  METHODS
  Medline/PubMed were systematically searched for eligible studies published up to 2010, reporting multivariate predictors of LMD or 3VD. Study features, patient characteristics, and prevalence and predictors of LMD and 3VD were abstracted and pooled with random-effect methods (95% CIs).
  
  
  RESULTS
  17 studies (22 740 patients) were included, 11 focusing on ACS (17 896 patients) and six on stable coronary disease (4844 patients). In the ACS subgroup, LMD or 3VD occurred in 20% (95% CI 7.2% to 33.4%), LMD in 12% (95% CI 10.5% to 13.5%), and 3VD in 25% (95% CI 23.1% to 27.0%). Heart failure at admission and extent of ST-segment elevation in lead aVR on 12-lead ECG were the most powerful predictors of LMD or 3VD. In the stable disease subgroup, LMD or 3VD was found in 36% (95% CI 18.5% to 48.8%), with the most powerful predictors being transient ischaemic dilation during the imaging stress test, extent of ST-segment elevation in aVR and V1 during the stress test, and hyperlipidaemia.
  
  
  CONCLUSIONS
  This meta-analysis demonstrated that severe coronary disease-that is, LMD or 3VD-is more common in patients with ACS or stable coronary disease than generally perceived, and that simple and low-cost tools may help in the selection of the most appropriate therapeutic approach.
authors.affiliation: Division of Cardiology, University of Turin, S Giovanni Battista Molinette Hospital, Corso Bramante 88-90, Turin 10126, Italy. fabrizio.dascenzo@gmail.com
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.forename: Davide Giacomo
authors.initials: DG
authors.lastname: Presutti
authors.forename: Elisa
authors.initials: E
authors.lastname: Picardi
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Omedè
authors.forename: Filippo
authors.initials: F
authors.lastname: Sciuto
authors.forename: Marco
authors.initials: M
authors.lastname: Novara
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Yan
authors.forename: Shaun
authors.initials: S
authors.lastname: Goodman
authors.forename: Nitin
authors.initials: N
authors.lastname: Mahajan
authors.forename: Masami
authors.initials: M
authors.lastname: Kosuge
authors.forename: Alberto
authors.initials: A
authors.lastname: Palazzuoli
authors.forename: Gwo-Ping
authors.initials: GP
authors.lastname: Jong
authors.forename: Hussain
authors.initials: H
authors.lastname: Isma'eel
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.forename: Ronen
authors.initials: R
authors.lastname: Rubinshtein
authors.forename: Henry
authors.initials: H
authors.lastname: Gewirtz
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Reed
authors.forename: Pierre
authors.initials: P
authors.lastname: Theroux
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Modena
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology*; D003331:Coronary Vessels; D004562:Electrocardiography; D014943:Global Health; D006801:Humans; D015995:Prevalence; D011379:Prognosis; D014481:United States / Q000453:epidemiology