The prognostic spectrum of left main stenosis.

Conley, Michael; Ely, R L; Kisslo, Joseph; Lee, K L; McNeer, J F; Rosati, Robert A.

doi:10.1161/01.cir.57.5.947

Cited by 239 publications

(92 citation statements)

References 9 publications

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“…In other studies also, triple vessel involvement is more common found in 50-80% in various series. 8 When the anatomical site of involvement in left main coronary artery was analysed, 17% had ostio-proximal involvement and 11% had mid shaft disease and in majority of cases distal disease was seen (70.3%) of them bifurcation disease was seen in 74 cases, ostia of both LAD and LCX was involved in 41 cases and ostium of LAD alone in 21 cases and ostium of LCX alone in 12 cases. Total occlusion was noted in one case.…”

Section: Discussionmentioning

confidence: 99%

Angiographic Profile of Left Main Coronary Artery (Lmca) Stenosis

Rao¹

2015

jemds

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Among patients with coronary artery disease, left coronary artery (LMCA) stenosis is the dangerous form of coronary arterial involvement, associated with increased mortality and morbidity unless immediate intervention is done. The gold standard treatment for left main coronary artery (LMCA) stenosis is the emergency coronary artery bypass grafting to its branches, left anterior descending artery (LAD), and left circumflex artery (LCX). Of percutaneous intervention in the form of angioplasty and stenting of left main coronary artery are increasingly done. The anatomy and the site of stenosis in the left main coronary artery determine the management option. In this context, the involvement of left main coronary artery and its anatomical pattern are important in deciding management options. AIM: To study the angiographic profile of significant Left main coronary artery (LMCA) stenosis among the patients who underwent coronary angiography. METHODS: A total of 1911 cases of significant coronary arterial disease, who underwent coronary angiography at King George Hospital, Visakhapatnam were studied in the present study and their coronary angiograms were analysed with respect to the pattern of involvement. RESULTS: of the 1911 cases of coronary artery disease, 118 patients have left main coronary artery disease. M/F ratio is 93/25. Of them 68.4% are hypertensive, 41.5 % are diabetics, 34.7% are smokers. Mean age of presentation was 59 yrs. Isolated LMCA involvement is seen in 5, associated with single vessel disease in 9, double vessel disease in 12 and triple vessel diseases in 93. Ostio-proximal involvement is seen in 21, mid segment involvement in 13, distal -bifurcation involvement in 93 and total occlusion of LMCA in 1 case. CONCLUSION: Significant LMCA involvement is seen in 6.1%. In majority of cases, it is associated with triple vessel disease and distal bifurcation is the commonest site involved. KEYWORDS: Left main coronary artery (LMCA), Left anterior descending artery (LAD), Left circumflex coronary artery (LCx), Bifurcation stenosis. INTRODUCTION:Among patients with coronary artery disease, left coronary artery (LMCA) stenosis is the dangerous form of coronary arterial involvement, associated with increased mortality and morbidity unless immediate intervention is done. The gold standard treatment for left main coronary artery (LMCA) stenosis is the emergency coronary artery bypass grafting to its branches, left anterior descending artery (LAD), and left circumflex artery (LCX). Of late percutaneus intervention in the form of angioplasty and stenting of left main coronary artery are increasingly done. 1 The LMCA refers to the proximal segment of the left coronary artery that arises from the left aortic sinus just below the sino tubular junction to its bifurcation into the left anterior descending (LAD) and left circumflex (LCx) arteries. The LMCA is responsible for supplying about 75% of the left ventricular (LV) cardiac mass in patients with right dominant type or balanced type and 100% in the ca...

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Section: Discussionmentioning

confidence: 99%

Angiographic Profile of Left Main Coronary Artery (Lmca) Stenosis

Rao¹

2015

jemds

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“…1 Compared with medical therapy (MT), coronary artery bypass graft (CABG) surgery improves survival in patients with ULMCAD by ≈66% at 3 years. [2][3][4][5][6][7][8][9] Accordingly, practice guidelines have assigned a Class I recommendation ("should be done") to CABG surgery to improve survival in patients with ULMCAD.…”

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confidence: 99%

Bayesian Methods Affirm the Use of Percutaneous Coronary Intervention to Improve Survival in Patients With Unprotected Left Main Coronary Artery Disease

Bittl

Jacobs

et al. 2013

Circulation

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Background-Several randomized clinical trials support the use of coronary artery bypass grafting (CABG) for patients with unprotected left main coronary artery disease. Studies suggesting the equivalence of percutaneous coronary intervention (PCI) with CABG for this indication indirectly support the 2011 American College of Cardiology Foundation/American Heart Association Class IIa recommendation for PCI to improve survival in patients with unprotected left main coronary artery disease. We tested whether bayesian approaches uphold the new recommendation. Methods and Results-We performed a bayesian cross-design and network meta-analysis of 12 studies (4 randomized clinical trials and 8 observational studies) comparing CABG with PCI (n=4574 patients) and of 7 studies (2 randomized clinical trials and 5 observational studies) comparing CABG with medical therapy (n=3224 patients). The odds ratios of 1-year mortality after PCI compared with CABG using bayesian cross-design meta-analysis were not different among randomized clinical trials (odds ratio, 0.99; 95% bayesian credible interval, 0.67-1.43), matched cohort studies (odds ratio, 1.10; 95% bayesian credible interval, 0.76-1.73), and other types of cohort studies (odds ratio, 0.93; 95% bayesian credible interval, 0.58-1.35). A network meta-analysis suggested that medical therapy is associated with higher 1-year mortality than the use of PCI for patients with unprotected left main coronary artery disease (odds ratio, 3.22; 95% bayesian credible interval, 1.96-5.30). Conclusions-Bayesian methods support the current guidelines, which were based on traditional statistical methods and have proposed that PCI, like CABG, improves survival for patients with unprotected left main coronary artery disease compared with medical therapy. An integrated approach using both direct and indirect evidence may yield new insights to enhance the translation of clinical trial data into practice.

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“…The heterogeneity of patients with left main lesions has been pointed out by several observers3' 21 but disputed by others,'9, 22 insofar as the need for surgical management is concerned. Conley et al,4 in their study of the natural history of the disease, found that medically treated patients with left main lesions less than 70% had survival rates similar to those of patients with three-vessel disease without left main lesions. A poorer prognosis was associated not only with lesions of 70% or greater, but also with certain noninvasive risk factors, including a history of congestive failure, the presence of rest pain, cardiomegaly, ST-segment depression on the resting ECG, and an abnormal left ventricular contraction pattern.…”

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confidence: 99%

“…4 In coronary heart disease patients without left main disease, a benefit from surgery has also been reported in subgroups based on clinical criteria alone.5 In this report, we examine the effects of bypass surgery on survival and on the incidence of myocardial infarction (MI) in angiographically and clinically defined subgroups of patients with left main coronary artery disease.…”

mentioning

confidence: 99%

Survival in subgroups of patients with left main coronary artery disease. Veterans Administration Cooperative Study of Surgery for Coronary Arterial Occlusive Disease.

Takaro¹,

Peduzzi²,

Detre³

et al. 1982

Circulation

266

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INTEREST in the management of patients with coronary artery disease has focused on subgroups of patients defined by arteriographic findings. In the Veterans Administration Cooperative Study, the first subgroup with significantly improved survival when managed surgically and followed for 2-3 years was that of patients with disease of the left main coronary artery.1 Other reports, including the only other randomized controlled study,2 confirmed this finding.Patients with left main disease are not a homogeneous group.3'4 Those with more severe stenosis or with an abnormality of left ventricular (LV) function were reported to have a worse prognosis.4 In coronary heart disease patients without left main disease, a benefit from surgery has also been reported in subgroups based on clinical criteria alone.5 In this report, we examine the effects of bypass surgery on survival and on the incidence of myocardial infarction (MI) in angiographically and clinically defined subgroups of patients with left main coronary artery disease. tients who had a significant stenosis (at least 50% reduction of the luminal diameter) of the left main coronary artery. The coronary arteriograms were reviewed to confirm the presence of a significant left main lesion and to assess the degree of stenosis. MIs that occurred after randomization were identified in accordance with definitions used by the Coronary Drug Project8 and by Hultgren et al.9 (appendix A). ECGs and autopsy protocols, as well as most left ventriculograms, were reviewed centrally (appendix B).In

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The prognostic spectrum of left main stenosis.

Cited by 239 publications

References 9 publications

Angiographic Profile of Left Main Coronary Artery (Lmca) Stenosis

Angiographic Profile of Left Main Coronary Artery (Lmca) Stenosis

Bayesian Methods Affirm the Use of Percutaneous Coronary Intervention to Improve Survival in Patients With Unprotected Left Main Coronary Artery Disease

Survival in subgroups of patients with left main coronary artery disease. Veterans Administration Cooperative Study of Surgery for Coronary Arterial Occlusive Disease.

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