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Is left main coronary artery stenosis a risk factor for early mortality in coronary artery surgery?
1Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Clinic, Ankara. nkgol@ato.org.tr
Insights
Prompt surgical intervention for critical left main coronary artery stenosis is crucial. Emergency operations significantly increase mortality risk compared to elective procedures for coronary artery bypass surgery.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Surgery Outcomes
Background:
- Surgical revascularization is the standard treatment for critical left main coronary artery (LMCA) stenosis.
- The role of critical LMCA stenosis as an independent risk factor in coronary artery bypass grafting (CABG) requires further evaluation.
Purpose of the Study:
- To assess critical LMCA stenosis as a risk factor in CABG outcomes.
- To compare surgical results between patients with and without LMCA disease, considering elective versus emergency surgery.
Main Methods:
- Retrospective comparison of 760 patients with critical LMCA disease (58 emergency, 702 elective) against 707 elective controls (CONT-el) and 99 emergency controls (CONT-em) without LMCA disease.
- Univariate and multivariate analyses, including logistic regression, were used to identify risk factors for mortality.
Main Results:
- Mortality was significantly higher in emergency groups (LMCA-em and CONT-em) compared to elective groups.
- Univariate analysis identified female gender, older age, diabetes, poor left ventricular function, and unstable angina as risk factors for mortality in elective groups.
- Multivariate analysis indicated that critical LMCA disease itself was not an independent risk factor for mortality, but diabetes, poor left ventricular function, and emergent operations were significant risk factors.
Conclusions:
- Prompt surgical intervention for LMCA disease is recommended to avoid emergency conditions, which are associated with higher mortality.
- Diabetes, impaired left ventricular function, and emergent surgical status are key predictors of early mortality in CABG patients.
Abstract:
It is accepted universally that the treatment of critical left main coronary artery (LMCA) stenosis is surgical revascularization. This study was designed to evaluate critical LMCA stenosis as a risk factor in coronary artery bypass surgery. We compared the surgical results of 760 patients with critical LMCA disease, including 58 cases who were operated under emergency conditions (LMCA-em) and 702 patients who were operated electively (LMCA-el), with randomly chosen 707 coronary bypass patients (CONT-el) without LMCA disease, but who had double- or triple-vessel disease. Another group of patients (n = 99) who were operated on under emergency conditions (CONT-em) but without LMCA disease were also compared with the corresponding groups. The mortality of LMCA-em group and CONT-em group was markedly higher from the other two groups. Univariate analysis revealed that female gender, older age, presence of diabetes mellitus, poor left ventricular function, and the presence of unstable angina were major risk factors for fatal outcome in LMCA-el and CONT-el groups. Age was also a risk factor in LMCA-em group, as well as unstable angina pectoris. The coexistence of critical right coronary artery disease did not affect the early outcome in both groups with LMCA lesions. In the multivariate analysis, critical LMCA disease was not a risk factor for mortality. Logistic regression analysis revealed diabetes [odds ratio (OR): 3.66], poor left ventricular function (higher left ventricle end-diastolic pressure, OR: 1.08), and emergent operations (OR: 5.09) were risk factors for early mortality. Patients with LMCA disease should have surgery promptly for favorable results, because emergency conditions have higher mortality rates.