Related Experiment Video
Updated: Feb 27, 2026
Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Comparative determinants of 5-year cardiovascular event rates in patients with unprotected left main coronary artery
Cheol Hyun Lee1, Jung-Min Ahn, Pil Hyung Lee
1aDepartment of Cardiology bDivision of Biostatistics, Center for Medical Research and Information, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Simple clinical factors like diabetes, low ejection fraction, and extent of coronary artery disease predict cardiovascular events in unprotected left main coronary artery disease. These factors help identify high-risk patients for better management.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Unprotected left main coronary artery (ULMCA) disease poses significant cardiovascular risk.
- Predictive roles of diabetes mellitus (DM), low ejection fraction (EF), and coronary artery disease (CAD) extent are known but their comparative impact in ULMCA disease is unclear.
Purpose of the Study:
- To categorize cardiovascular event risk in ULMCA disease patients using simple clinical descriptors.
- To assess the comparative contributions of DM, low EF, and CAD extent to future cardiovascular events in ULMCA disease.
Main Methods:
- Analysis of 5975 ULMCA disease patients from the Interventional Research Incorporation Society-Left MAIN Revascularization registry.
- Patients were treated with percutaneous coronary intervention, coronary artery bypass grafting, or medical therapy.
- Major adverse cardiac or cerebrovascular event (MACCE) was the primary outcome, defined as death, stroke, myocardial infarction, or repeat revascularization.
Main Results:
- Five-year MACCE rates were 42.5% (medical), 25.7% (PCI), and 19.9% (CABG) (P<0.001).
- DM (HR: 1.25), low EF ≤40% (HR: 1.83), and extent of CAD (HR: 1.14) were independent predictors of MACCE.
- These risk factors significantly increased MACCE risk irrespective of treatment strategy.
Conclusions:
- Simple clinical descriptors effectively identify high-risk patients with ULMCA disease.
- DM, low EF, and extent of CAD are crucial for predicting future cardiovascular events in ULMCA disease patients.
- These findings aid clinicians in risk stratification and management decisions for ULMCA disease.
Background:
Diabetes mellitus (DM), low ejection fraction (EF), and the extent of coronary artery disease (CAD) have all been identified as predictors of cardiovascular events in multivessel disease, but their comparative contributions to future risk remain unclear in patients with unprotected left main coronary artery (ULMCA) disease. Through this study we aimed to categorize the risk for cardiovascular events in patients with ULMCA disease using simple clinical descriptors.
Patients And Methods:
Our study included a total of 5975 patients with ULMCA disease from the Interventional Research Incorporation Society-Left MAIN Revascularization registry who were treated with percutaneous coronary intervention (n=2850), coronary artery bypass grafting (n=2337), or medical therapy alone (n=608). We categorized the risk for cardiovascular events using simple clinical descriptors (DM, low EF, and the extent of CAD). The primary outcome was a major adverse cardiac or cerebrovascular event (MACCE) (i.e. death from any cause, stroke, myocardial infarction, or repeat revascularization).
Results:
Overall, the 5-year rate of MACCE was highest in the medical group, lower in the percutaneous coronary intervention group, and lowest in the coronary artery bypass grafting group (42.5, 25.7, and 19.9%, respectively; P<0.001). In multivariable modeling, the presence of DM [hazard ratio (HR): 1.25; 95% confidence interval (CI): 1.12-1.40; P<0.001], low EF of 40% or less (HR: 1.83; 95% CI: 1.56-2.15; P<0.001), and the extent of CAD (HR: 1.14; 95% CI: 1.08-1.21; P<0.001) were independent predictors of MACCE; in addition, these factors were consistently associated with a significantly higher risk for MACCE, regardless of index treatment strategies.
Conclusion:
Simple clinical descriptors can assist clinicians in identifying high-risk patients and in predicting future cardiovascular events within the broad range of risk factors for ULMCA disease.
More Related Videos
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
04:41Digital PCR for Quantifying Circulating MicroRNAs in Acute Myocardial Infarction and Cardiovascular Disease
Published on: July 3, 2018
Related Concept Videos
01:26Coronary Artery Disease II: Pathophysiology
01:26Coronary Artery Disease IV: Preventive Measures
01:30Coronary Artery Disease I: Introduction
01:30Coronary Artery Disease III: Clinical Manifestations
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
01:30Acute Coronary Syndrome III: Diagnostic Studies