Abstract 19962: Total Arterial Revascularization is Safe and Efficacious in Patients With Isolated Left Main Coronary Artery Disease
Objective: Current guidelines recommend total arterial revascularization (TAR) in patients with reasonable life expectancy. However, controversies still exist on the use of TAR in patients with isolated left main disease (LMD) due to a high degree of competitive flow. Our study aimed to compare the early and late clinical outcomes of TAR in patients with isolated LMD to those with LMD and additional single or multivessel disease.
Methods: A total of 1142 patients with LMD underwent TAR between September 2001 and October 2015 in our institution. Of these, 151 patients had isolated LMD (Group 1) and 991 patients had additional single or multivessel disease (Group 2). Group 2 patients were older (p=0.004) with a higher prevalence of comorbidities such as peripheral vascular disease (p=0.04), prior cerebrovascular accident (p=0.02) and myocardial infarction (p=0.05) than Group 1 patients. To mitigate bias arising from differences in these covariates, we performed a propensity score matched analysis. The matched cohort consisted of 302 patients; 151 patients in each group.
Results: In-hospital mortality for Groups 1 and 2 was 1.3% and 1.8% (p=1.0) before and 1.3% and 0.7%, (p=1.0) after matching, respectively. The corresponding 6-year survival was 94.7±2% vs. 84.5±2% (log-rank p=0.004) before and 94.7±2% vs. 92.7±2% (log-rank p=0.53) after matching. Preoperative critical state (odds ratio [OR]:3.6; p=0.03), left ventricular ejection fraction (LVEF) (OR:1.2; p=0.01) and age (OR:1.2; p=0.03) were independent predictors of in-hospital mortality in the unmatched cohort. Long-term mortality for the unmatched cohort was predicted by prior cerebrovascular accident (hazard ratio [HR]:3.0;p<0.001), preoperative critical state (HR:2.7;p=0.01), diabetes (HR:1.8;p=0.003), age (HR:1.1;p<0.001) and LVEF (HR:1.1;p=0.001). The type or severity of LMD did not predict early or late mortality.
Conclusions: Our study revealed that TAR in patients with LMD is associated with excellent early and long-term survival. We found no difference in outcomes between patients undergoing TAR for isolated LMD and those undergoing TAR for LM plus single/multivessel disease. Thus, TAR appears to be a safe and efficacious for patients with isolated LMD.
Author Disclosures: P. Davierwala: None. A. Verevkin: None. S. Leontyev: None. F. Bakhtiary: None. M. Misfeld: None. F.W. Mohr: None.
- © 2016 by American Heart Association, Inc.