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Published on: January 28, 2020
The prognostic importance of nonsignificant left main coronary artery disease in patients undergoing percutaneous
Gabor Gyenes1, Fiona M Shrive, Michelle M Graham
1University of Alberta, Edmonton, Alberta, Canada. ggyenes@cha.ab.ca
Insights
Nonsignificant left main coronary artery disease (<50%) in patients undergoing percutaneous coronary intervention (PCI) does not independently impact survival. Increased mortality risk is linked to co-morbidities, not the stenosis itself.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Prognostic significance of nonsignificant (<50%) left main coronary artery disease (LMCAD) remains unclear.
- Nonsignificant LMCAD may influence revascularization decisions in patients with coronary artery disease.
Purpose of the Study:
- To investigate the association between nonsignificant (<50%) left main coronary artery disease (LMCAD) and patient survival after percutaneous coronary intervention (PCI).
Main Methods:
- Analysis of mortality and repeat catheterization rates in 11,855 patients undergoing PCI (1996-2001).
- Comparison of outcomes between patients with and without nonsignificant LMCAD.
- Secondary analysis of 34,586 patients undergoing cardiac catheterization.
Main Results:
- Patients with nonsignificant LMCAD had higher baseline co-morbidities and a significantly higher crude mortality rate at 1 year (4.4% vs. 3.4%).
- After risk adjustment, the 7-year mortality hazard ratio for PCI patients with <50% LMCAD versus no LMCAD was 0.98 (95% CI 0.79 to 1.23).
- Repeat catheterization rates did not differ between groups; secondary analysis showed an adjusted HR of 1.03 (95% CI 0.94 to 1.14).
Conclusions:
- Nonsignificant (<50%) left main coronary artery disease (LMCAD) is associated with a nonsignificant increase in mortality risk post-PCI.
- The observed increased mortality risk appears attributable to higher co-morbidity burden, not the left main stenosis itself.
- These findings suggest that nonsignificant LMCAD does not independently worsen outcomes in patients undergoing PCI.
Objectives:
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.
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