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[Medical therapy in patients with left main coronary artery stenosis]
T Maruyama1, K Haze, T Sumiyoshi
1Division of Cardiology, National Cardiovascular Center, Suita.
Insights
Medically treated patients with severe left main coronary artery (LMCA) lesions can have good prognoses if they respond well to medication. However, poor collateral circulation, prior myocardial infarction (MI), and high left ventricular end-diastolic pressure are risk factors.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Prognosis
Background:
- Left main coronary artery (LMCA) lesions pose significant risks.
- Long-term prognosis for medically treated LMCA patients requires further elucidation.
Purpose of the Study:
- To determine the long-term prognosis of patients with LMCA lesions treated medically.
- To identify risk factors associated with adverse cardiac events in medically treated LMCA patients.
Main Methods:
- Retrospective analysis of 116 patients with LMCA lesions.
- Comparison between medically treated (Group M) and coronary artery bypass graft (CABG) groups (Group S).
- Follow-up assessment of cardiac events and survival rates.
Main Results:
- Medically treated patients (Group M) had a higher incidence of cardiac events than CABG patients (Group S).
- Two-year cardiac event-free rate was 77%, with a cumulative survival rate of 83% in Group M.
- Similar cardiac event rates were observed between groups for patients with good collateral circulation, no prior MI, and low LV end-diastolic pressure.
Conclusions:
- Japanese patients with severe LMCA lesions responding to pharmacological treatment show good prognoses.
- Obstructed collateral circulation, prior MI, and high LV end-diastolic pressure are high-risk factors for medically treated patients.
Abstract:
To elucidate the long-term prognosis of medically-treated patients with left main coronary artery (LMCA) lesions, 119 consecutive patients with LMCA lesions undergoing coronary angiography were analyzed retrospectively. Among these, 3 patients died soon after angiography and were excluded from this study. Among the remaining 116 patients, 22 were treated medically (Group M) for the following reasons: profound left ventricular (LV) dysfunction (3 patients), effective pharmacological treatment (10), and patients' refusal of surgical therapy (9). Among 94 patients who underwent coronary artery bypass graft (CABG), 83 patients survived (Group S). During the follow-up period, cardiac events occurred in 5 patients in Group M; cardiac deaths in 3, non-fatal myocardial infarction (MI) in one and late application of CABG in one. Two-year cardiac event-free rate after diagnosis was 77%, which remained unchanged thereafter. The cumulative survival rate was 83%. The incidence of cardiac events in Group M was higher than that in Group S (p < 0.01). However, cardiac event rates were similar between these 2 groups for patients with good collateral circulations to the left coronary arteries, no preceding MI and LV end-diastolic pressure less than 15 mmHg. We concluded that the Japanese patients with severe LMCA lesions who respond favorably to pharmacological intervention have unexpectedly good prognoses, however, obstructed collateral circulation to the left coronary system, the presence of preceding MI and high LV end-diastolic pressure were all high-risk factors for medically-treated patients.