Can patients with left main coronary artery disease wait for myocardial revascularization surgery?

Abstract

or = 50%) consecutively identified on diagnostic cardiac catheterization during an 8-month period were selected for the study. The group comprised 56 patients (40 males and 16 females) with a mean age of 61±10 years. The cardiac events included death, nonfatal acute myocardial infarction, acute left ventricular failure, unstable angina, and emergency surgery. RESULTS: While waiting for surgery, patients experienced the following cardiac events: 7 acute myocardial infarctions and 1 death. All events occurred within the first 60 days after the diagnostic cardiac catheterization. More patients, whose indication for diagnostic cardiac catheterization was unstable angina, experienced events as compared with those with other indications [p=0.03, relative risk (RR) = 5.25, 95% confidence interval = 1.47 - 18.7]. In the multivariate analysis of logistic regression, unstable angina was also the only factor that independently contributed to a greater number of events (p = 0.02, OR = 8.43, 95% CI =1.37 - 51.7). CONCLUSION: Unstable angina in patients with left main coronary artery disease acts as a high risk factor for cardiac events, emergency surgery being recommended in these cases.]]>

Preoperative Clinical Status but not Waiting Time Predicts In-Hospital Outcomes of Surgery in Patients with Left Main Coronary Artery Stenosis

“…They reported that myocardial infarction within 7 days before surgery, preopera-tive renal failure, ejection fraction of less than 40%, age greater than 70 years and stenosis of LMCA greater than 70% were independent predictors of the worse outcome. Da Rocha and da Silva (2003) reported that only unstable angina independently predicted worse outcomes in patients with LMCA stenosis. Virani et al (2006) reported that only unstable angina or myocardial infarction was associated with worse oucome in this population.…”

“…Although percutaneous coronary intervention can be performed for unprotected LMCA stenosis, surgery is still the preferred method of treatment in most centers (Tan et al 2001;Takagi et al 2002). Studies performed to find out the optimal operating time for patients with LMCA disease are limited and have given contraversial results (Maziak et al 1996;Gol et al 2000;Da Rocha and da Silva 2003;Legare et al 2005;Virani et al 2006). Although some studies report that the risk is not increased as preoperative waiting time prolongs, they were not primarily focused on the patients with LMCA stenosis (Morgan et al 1998;Rexius et al 2004).…”

Assessing the risk of waiting for coronary artery bypass graft surgery among patients with stenosis of the left main coronary artery

“…6,8,11,13 Our findings contrast with others that have suggested that stenosis of the left main coronary artery may be associated with an increased risk of death. 4,14 However, many of these studies were limited by their small size (n = 56-90). Supporting our findings of no association with increased mortality were results from a large study involving more than 5864 consecutive patients waiting for CABG.…”

Left Main Coronary Artery Disease: Current Status and Management

“…Rocha и соавт. среди 56 пациентов с поражением ствола ЛКА, находя-щихся на листе ожидания КШ, у 7 определялись неблаго-приятные кардиальные события (6 инфарктов миокарда и 1 смерть) [22]. Стратификация пациентов по экстренно-сти выполнения КШ не позволила предотвратить смерт-ность в период ожидания операции.…”