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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

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

Gabor Gyenes, MD, PhD^_*,_*, Fiona M. Shrive, BSc, Michelle M. Graham, MD, FRCP(C)^_*, William A. Ghali, MD, FRCP(C), Merrill L. Knudtson, MD, FCRP(C) for the APPROACH Investigators¹

^_* University of Alberta, Edmonton, Alberta, Canada
University of Calgary, Calgary, Alberta, Canada.

Manuscript received December 31, 2005; revised manuscript received February 16, 2006, accepted February 21, 2006.

^_* Reprint requests and correspondence: Dr. Gabor Gyenes, University of Alberta Hospital, 2C2 Walter Mackenzie Health Sciences Centre, 8440-112 Street, Edmonton, AB, Canada T6G 2B7. (Email: ggyenes{at}cha.ab.ca).

OBJECTIVES: 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).

BACKGROUND: The prognostic importance of nonsignificant LMCAD is unknown; however, the co-existence of nonsignificant LMCAD may influence revascularization decisions.

METHODS: 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.

RESULTS: 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).

CONCLUSIONS: 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.

Abbreviations and Acronyms   APPROACH = Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease   CABG = coronary artery bypass grafting   CI = confidence interval   HR = hazard ratio   IVUS = intravascular ultrasound   LMCAD = left main coronary artery disease   PCI = percutaneous coronary intervention

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