Long-Term Outcomes in a Contemporary Population Being Managed Medically for Significant Left Main Stenosis.

Abstract

Background: While revascularisation of obstructive left main (LM) disease with CABG or PCI is considered the gold standard, patient-specific risk factors may preclude any type of intervention. Data on the outcomes of this cohort are limited, particularly with contemporary medical therapy. Method(s): Consecutive medically managed patients with surgical coronary anatomy discussed at a cardiac case conference at a tertiary Australian institution were included between 2012-2021. Severe LM stenosis was defined as a stenosis of >=50%. Rates of hospital readmission and long-term mortality were recorded. Comparison was made between those with and without severe LM stenosis. Result(s): 120 patients with surgical anatomy were managed medically following multidisciplinary discussion. Of these, 27 patients (22.5%) had a severe stenosis of their LM coronary artery. Median follow-up was 3.6 years (IQR 1.9-6.4). Both groups were similar with regards to age (76.3 years (68.9-82.1) vs 72.7 (64.5-80.4), p=0.13), male gender (18 (66.7%) vs 67 (72.0%), p=0.64) and prevalence of diabetes (16 (59.3%) vs 52 (55.9%), p=0.72). Cardiac death was similar at 12 months (4 (14.8%) vs 9 (9.7%), p=0.44) and maximal follow up (7 (25.9%) vs 24 (25.8%), p=0.97) (Figure). There was no difference in rates of 12 month hospital readmission (20 (74.1%) vs 60 (64.5%), p=0.32). Conclusion(s): The presence of severe LM stenosis in contemporary medically managed patients with surgical coronary anatomy did not predict a worse prognosis. [Formula presented]Copyright � 2024