Is left main coronary artery stenosis a risk factor for early mortality in coronary artery surgery?

Intensive care outcome of left main stem disease surgery: A single center three years’ experience

BACKGROUND

Left main coronary artery (LMCA) supplies more than 80% of the left ventricle, and significant disease of this artery carries a high mortality unless intervened surgically. However, the influence of coronary artery bypass grafting (CABG) surgery on patients with LMCA disease on morbidity intensive care unit (ICU) outcomes needs to be explored. However, the impact of CABG surgery on the morbidity of the ICU population with LMCA disease is worth exploring.

AIM

To determine whether LMCA disease is a definitive risk factor of prolonged ICU stay as a primary outcome and early morbidity within the ICU stay as secondary outcome.

METHODS

Retrospective descriptive study with purposive sampling analyzing 399 patients who underwent isolated urgent or elective CABG. Patients were divided into 2 groups; those with LMCA disease as group 1 (75 patients) and those without LMCA disease as group 2 (324 patients). We correlated ICU outcome parameters including ICU length of stay, post-operative atrial fibrillation, acute kidney injury, re-exploration, perioperative myocardial infarction, post-operative bleeding in both groups.

RESULTS

Patients with LMCA disease had a significantly higher prevalence of diabetes (43.3% vs 29%, P = 0.001). However, we did not find a statistically significant difference with regards to ICU stay, or other morbidity and mortality outcome measures.

CONCLUSION

Post-operative performance of Patients with LMCA disease who underwent CABG were comparable to those without LMCA involvement. Diabetes was more prevalent in patients with LMCA disease. These findings may help in guiding decision making for future practice and stratifying the patients’ care.

Clinical presentation and cardiovascular risk profiles in patients with left main coronary artery disease in a middle eastern country

We evaluated the prevalence and clinical profile of patients with left main coronary artery disease (LMCA) in Qatar between 2006 and 2010. Patients were divided into 2 groups: patients with LMCA and patients without LMCA but had severe 3-vessel disease (VeD) eligible for surgical revascularization. Among 7000 patients who underwent coronary angiography, 210 patients had significant LMCA and 200 patients with severe 3VeD were matched for age and sex. Diabetes mellitus and hypertension were comparable in the 2 groups. Presentations with myocardial infarction or heart failure were comparable in both groups. Isolated LMCA was 4-fold higher in women (P = .02). Dyslipidemia and smoking were more prevalent in patients with distal and proximal lesions, respectively. Renal failure was independent predictor of LMCA (adjusted odds ratio: 2.6; 95% confidence interval: 1.43-4.69). One-year mortality was higher in LMCA (P = .01). The LMCA carries high mortality. Certain cardiovascular risk factors were important predictors of stenosis site.

Grade of left main coronary artery stenosis does not influence long-term mortality after coronary artery bypass surgery

OBJECTIVE

To assess if grade of left main coronary artery (LMCA) stenosis influences early or long-term mortality after coronary artery bypass grafting (CABG).

DESIGN

Among all 1 384 patients with LMCA stenosis at Karolinska Hospital, Stockholm, Sweden during 1990-1999, 131 deaths occurred within 5 years of surgery (cases). Matched controls (n=146) were randomly selected from all surviving LMCA patients taking gender, age and year of surgery into account. Angiographies were classified for grade of LMCA stenosis before the operation.

RESULTS

High-grade LMCA stenosis was equally common among cases and controls (50 vs. 45%). The odds ratio (OR) of mortality 5 years after the operation in patients with high-grade versus low-grade LMCA stenosis based on the matched pairs was 1.2 (95% confidence interval (CI) 0.7-2.0) and after multivariable adjustment using information on all subjects the OR was 1.0 (95% CI 0.6-1.7). For early and one year mortality similar odds ratios were observed but with wide confidence intervals.

CONCLUSIONS

Grade of LMCA stenosis does not appear to influence early or long-term mortality after CABG performed during 1990-1999.