The Prognostic Importance of Nonsignificant Left Main Coronary Artery Disease in Patients Undergoing Percutaneous Coronary Intervention

• Published in: Journal of the American College of Cardiology Vol. 48; no. 2; pp. 276 - 280
• Main Authors: Gyenes, Gabor, Shrive, Fiona M., Graham, Michelle M., Ghali, William A., Knudtson, Merrill L.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 18-07-2006; Elsevier Science; Elsevier Limited
• Subjects: Aged; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Comorbidity; Coronary Disease - epidemiology; Coronary Disease - mortality; Coronary Disease - pathology; Coronary Disease - therapy; Coronary heart disease; Coronary Stenosis - epidemiology; Coronary Stenosis - mortality; Coronary Stenosis - pathology; Coronary vessels; Coronary Vessels - pathology; Female; Heart; Heart attacks; Humans; Male; Medical research; Medical sciences; Middle Aged; Mortality; Prognosis; Registries; Retreatment; Risk Assessment; Stents; Alberta Canada; APPROACH; CI; LMCAD; PCI; IVUS; HR; CABG; Human; Prognosis; Angioplasty; Coronary artery; Instrumentation therapy; Cardiovascular disease; Left coronary artery; Circulatory system; Cardiology; Coronary heart disease; Phlebology
• DOI: 10.1016/j.jacc.2006.02.067
• EISSN: 1558-3597
• ISSN: 0735-1097

The Prognostic Importance of Nonsignificant Left Main Coronary Artery Disease in Patients Undergoing Percutaneous Coronary Intervention
Gabor Gyenes, Fiona M. Shrive, Michelle M. Graham, William A. Ghali, Merrill L. Knudtson, for the APPROACH Investigators
The outcomes of 11,855 percutaneous coronary intervention (PCI) patients of whom 11.7% had nonsignificant left main coronary artery stenosis (LMCAD) were compared with those without LMCAD. The full cohort of 34,586 patients undergoing cardiac catheterization was analyzed separately. The PCI patients’ 7-year crude mortality hazard ratio (HR) was 1.18 (95% confidence interval [CI]: 0.94 to 1.46). After adjustment for differences in baseline clinical profile, the HR decreased to 0.98 (95% CI: 0.79 to 1.23). The full cohort showed similar trends. Patients with <50% LMCAD have a non-significantly increased 18% relative risk for mortality that appears to be related to these patients’ higher incidence of co-morbidities rather than the left main stenosis itself.
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).
The prognostic importance of nonsignificant LMCAD is unknown; however, the co-existence of nonsignificant LMCAD may influence revascularization decisions.
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.
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).
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.