Abstract 15014: Initial Clinical Indications for Revascularization Determine the Cardiovascular Outcomes In Patients with Unprotected Left Main Coronary Artery Stenosis
Introduction: The simple risk stratification that identify high-risk subsets of patients with unprotected left main coronary artery (ULMCA) stenosis undergoing revascularization has not been well established. We assessed the hypothesis that initial clinical indication for revascularization such as stable angina, unstable angina and non-ST elevation myocardial infarction (NSTEMI) may determine the long-term risk of cardiovascular outcomes in patients with ULMCA stenosis.
Methods: Between January 2000 and June 2006, 2,240 patients who underwent percutaneous coronary intervention (PCI) with stenting (n=1,102) or coronary-artery bypass surgery (CABG) (n=1,138) for the ULMCA stenosis were followed up to at least 3 years and stratified by their clinical indication for revascularization. The end points of the study were the composite of death, Q-wave myocardial infarction, or stroke.
Results: During follow-up period, a total of 352 patients experienced at least 1 event, including 328 with cardiovascular death. Patients with NSTEMI (n=220) had the highest rate of subsequent cardiovascular events (24.8%; 95% confidence interval [CI] 21.5%-28.1%); patients with unstable angina (n=1384) had a lower risk (18.2%; 95% CI 16.9%-19.5); and patients with stable angina (n=636) had the lowest risk (16.1%; 95% CI 14%-18.2%) (P<0.001 for NSTEMI vs. stable and unstable angina) (Figure). These outcomes were consistent after adjustment of concomitant covariates.
Conclusions: Simple clinical descriptor such as initial clinical indication for revascularization may assist the clinicians in identifying high-risk patients after revascularization for ULMCA stenosis. Event in acute coronary syndrome, there was significant separation of outcomes according to unstable angina vs. NSTEMI.
- © 2011 by American Heart Association, Inc.