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[Constriction of the left main coronary artery. Early and long term treatment outcome]
J Korzeniowska1, L Małecka, Z Juraszyński
1Kliniki Kardiologii Ogólnej oraz, Warszawie.
Insights
Surgical intervention for left main coronary artery stenosis (LMCA) offers a better prognosis than medical treatment. Patients undergoing bypass surgery experienced significantly better outcomes and survival rates compared to those treated non-surgically.
Area of Science:
- Cardiology
- Vascular Surgery
Context:
- Left main coronary artery stenosis (LMCA) is a critical condition.
- Understanding the clinical presentation and outcomes is vital for patient management.
Purpose:
- To evaluate the clinical presentation, course, and prognosis of patients with significant left main coronary artery stenosis (>50%).
- To compare the outcomes of surgical bypass versus medical management for LMCA.
Summary:
- This study analyzed 45 patients with significant LMCA stenosis, assessing their symptoms, ECG findings, and exercise test results.
- Surgical bypass was performed in 38 patients (85%), with a 10.5% perioperative mortality. Of the 34 survivors, 30 were asymptomatic.
- Seven patients received medical treatment; 42% died, and only 2 survivors were asymptomatic at follow-up.
Impact:
- Surgical treatment for significant LMCA stenosis leads to a good prognosis and improved long-term survival.
- Medical management of LMCA stenosis is associated with higher mortality and poorer outcomes.
Abstract:
Clinical presentation and course were studies in 45 consecutive patients (p)--39 males, 6 females with angiographically proven left main coronary artery stenosis (LMCA) > 50%. Mean age was 54.7 years. Three (6%) had no history of chest pain, 2 p (4%) had atypical chest pain, and the remaining (90%) had typical angina pectoris. 19 p (42%) had unstable angina, 20 p (44%) had suffered a myocardial infarction in the past. Outside an episode of chest pain most of the patients had an abnormal ECG with ST-T segment depression 2 mm or more in leads V3-6 and ST-T elevation in leads V1 and aVR. No significant differences were found when the abnormalities of the ST-T segment were compared to severity of LMCA obstruction. A symptom limited exercise test was performed in 17 (37%) p. It was abnormal in 13 p (29%). Thirty eight patients (85%) underwent bypass surgery and the mean number of bypass graft was 3.3. Seven patients were treated medically. In the surgical group four p (10.5%) died perioperatively. All of them had subtotal occlusion of LMCA, without significant lesions in the remaining coronary arteries, the ejection fraction (EF) was above 66%. Among thirty four living patients thirty have been asymptomatic. In the medically treated group 3 p (42%) died and only two of four survivors were asymptomatic at a mean follow-up 35.7 months. Left ventricle of all died patients were severely damaged (EF mean 28%), right coronary artery (RCA) was totally occluded and all had rythm disturbances. We conclude, that patients with significant LMCA stenosis had a good prognosis when treated surgically.(ABSTRACT TRUNCATED AT 250 WORDS)