One year follow-up of unprotected left main coronary artery disease, a prospective cohort study of 139 patients

Abbas  Andishmand; Seyedeh Mahdieh  Namayandeh; Seyed Jalil  Mirhosseini; Ahmad  Masoudi; Mojtaba  Andishmand

doi:10.18502/cbj.v1i2.10587

Abbas Andishmand Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Seyedeh Mahdieh Namayandeh Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Seyed Jalil Mirhosseini Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Ahmad Masoudi Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Mojtaba Andishmand Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

DOI: https://doi.org/10.18502/cbj.v1i2.10587

Keywords: unprotected Left main coronary artery disease (LMCAD), Event-free Survival, Major Cardiac and cerebral events (MACCE)

Abstract

Objectives: Coronary artery revascularization is the standard treatment for patients with severe left main coronary artery disease (LMCAD). In cases where the patient refuses surgical revascularization or PCI, medical treatment will be the only option. The purpose of this study was to compare the one-year outcomes of patients with (LMCAD) in terms of surgical or medical treatment.

Methods: This prospective cohort study was conducted on 139 patients (91 men and 48 women) with severe left main coronary artery disease who were diagnosed by coronary angiography from 1^st Mar 2014 to 28^th Feb 2014. Patients were followed up for one year as to major adverse cardiac and cerebral events (MACCE) including death, non-fatal myocardial infarction, stroke, and hospitalization.

Results: From total of 2661 coronary angiographies, 139 patients (5.2%) with a mean age of 63.2±7.2 years had LMCAD. The mortality rate in the medical treatment group and the surgical group appeared to be 16.7% (6 cases) and 8.7% (9 cases) respectively (p =.156). The rate of stroke in the medical group turned out to be 5.6% (n=2) and in the surgery group 2% (n=2) (p =.27). The rehospitalization rate was 19.4% in the medical treatment group but 4.9% in the surgical group (p =.013). During one year, the survival rate was significantly lower in the medical group than the group undergoing coronary artery bypass graft surgery (58.3% vs. 84.5%) (p =.002).

Conclusions: In the short term, the optimal medical treatment of patients with LMCAD was not significantly different from that of CABG patients in terms of fatal cardiac and cerebral events. However, rehospitalization was more common due to recurrent angina pectoris.