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[Stenosis of the common trunk with and without ostium involvement: clinical and angiographic characteristics]
L Bernardes1, L Patrício, A Cequier
1Interno de Cardiologia do Hospital Santa Marta.
Insights
Patients with left main coronary artery ostial stenosis (LM-OS) often present with a history of hypertension and less associated coronary disease compared to those without ostial stenosis (LM-NOS). This study evaluated clinical and angiographic differences in these patient groups.
Area of Science:
- Cardiology
- Interventional Cardiology
- Coronary Artery Disease
Background:
- Left main coronary artery stenosis is a critical condition.
- Distinguishing between ostial (LM-OS) and non-ostial (LM-NOS) stenosis is important for treatment strategies.
- Understanding the clinical and angiographic profiles aids in patient management.
Purpose of the Study:
- To compare the clinical and angiographic characteristics of patients with left main coronary artery stenosis with ostial stenosis (LM-OS) versus those without ostial stenosis (LM-NOS).
Main Methods:
- Retrospective analysis of 139 patients with significant left main stenosis (≥50%) undergoing coronary angiography.
- Patients were categorized into LM-OS (n=22) and LM-NOS (n=105) groups.
- Clinical data (age, gender, risk factors, medical history) and angiographic variables (stenosis severity, number of diseased vessels, ventricular function) were analyzed.
Main Results:
- The incidence of LM-OS was 0.4% in the overall study population.
- Patients with LM-OS showed a higher prevalence of arterial hypertension (73% vs 47%) compared to LM-NOS.
- LM-OS patients had fewer associated diseased vessels (1.3 vs 2.1) and a trend towards less associated coronary disease (18% vs 7%).
- Stenosis severity was similar between groups (80% in LM-OS vs 75% in LM-NOS).
Conclusions:
- Patients with left main coronary artery ostial stenosis (LM-OS) are more frequently associated with a history of arterial hypertension.
- LM-OS is linked to a lower burden of associated coronary artery disease, indicated by fewer diseased vessels.
- These findings suggest distinct clinical and angiographic profiles for LM-OS compared to LM-NOS, potentially influencing therapeutic decisions.
Study Objective:
To evaluate the clinical and angiographic profile of patients with left main coronary artery stenosis with (LM-OS) and without left coronary ostial stenosis (LM-NOS).
Design:
Retrospective study of patients submitted to coronary angiography.
Setting:
Laboratory of Hemodynamics and Interventional Cardiology at Bellvitge Hospital -Barcelona, Spain.
Participants:
4663 consecutive patients (pts) with angiographically defined coronary artery disease. 139 pts had left main stenosis greater than or equal to 50%. Twelve pts were excluded because nonatheroesclerotic disease. Twenty two pts (17%), had LM-OS and 105 (83%) LM-NOS.
Interventions:
Pts records were reviewed, to analyse the following clinical and angiographic variables: age, gender, risk factors to coronary artery disease, history of myocardial infarction, anginal class, presence of unstable angina, basal ECG ischemia, percentage and localization of left main stenosis, number and degree of vessels diseased, indexes of left ventricular function and coronary dominance.
Main Results:
1. Clinical characteristics--In the LM-OS group 18 pts were male and 4 female, while in the LM-NOS the numbers were respectively 90 and 15, p = ns. As for the gender the age showed also a similarity: 58 +/- 8 and 57 +/- 8 years, p = ns. A history of arterial hypertension was present in 73% of pts with LM-OS and 47% with LM-NOS, p greater than 0.05. With respect to the other clinical variables both groups were similar. The incidence of LM-OS was 0.4%. 2. Angiographic characteristics--The severity of left main stenosis was identical in the two groups: 80 +/- 15 in LM-OS and 75 +/- 16% in LM-NOS (p = NS). Four (18%) of the pts with LM-OS had no associated coronary disease versus 7 (7%) of the LM-NOS (p = 0.08). There were 1.3 +/- 1 diseased vessels in the LM-OS group and 2.1 +/- 1 in the LM-NOS (p greater than 0.01).
Conclusions:
In the present series, the clinical and hemodynamic profile of patients with left main disease suggest that the following characteristics are more frequently seen in patients with ostial stenosis: 1) history of arterial hypertension; 2) no associated coronary disease; 3) smaller number of diseased vessels; 4) less significant stenosis.