Long-term Outcomes And Quality Of Life Study On Intermediate Left Main Coronary Artery Disease

BackgroundThe prognosis of left main coronary artery disease (LMCAD) is poor without revascularization. The introductions of drug-eluting stents (DES) and advances in catheter techniques have led to much wider appliance of percutaneous coronary intervention (PCI) for LMCAD.2011American College of Cardiology Foundation (ACC) guidelines on PCI stated that it was reasonable to consider PCI in patients with low to intermediate anatomic complexity that are at increased surgical risk. Intermediate Left main coronary artery disease is defined as left main lesions with40%to60%stenosis. There are limited studies on intermediate left main coronary artery lesions, and we are not clear about the long term outcomes after PCI. Currently there hadn’t any studies on the quality of life and angina symptoms for intermediate left main coronary artery disease.Methods301intermediate left main coronary artery disease patients hospitalized in Sir Run Run Shaw Hospital from September2006to June2013were enrolled and divided into PCI group and Non-PCI group based on whether they had PCI on the LMCAD or not. Patients have been followed for27±17months, and151of the enrolled patients have finished the Seattle Angina Questionnaire and European Quality of life-five dimensions (EQ-5D). The primary endpoints are Major Adverse Cardiac and Cerebrovascular Event (MACCE). Kaplan-Meier survival analysis was done, and we use log-rank test to compare the survival curves of two groups. Cox regression analysis was performed to determine the risk factors of long term outcomes. We use Univariate ANOVA analysis to determine the differences of SAQ and EQ-5D.ResultsAnalysis of the baseline characters suggests significant difference regarding items of GFR<60ml/h and Ejection Fraction<40%between PCI group and Non-PCI group. The1st year MACCE rates of intermediate LMCAD patients are90.0%, with a2nd year rate84.1%and3rd year rate77.7%. The1st survival rates of intermediate LMCAD patients are95%, with a2nd year rate88.9%and3rd year rate85.9%. There has no significant difference between survival curves of the two groups. Aging, smoking, Stroke history, Diabetes, EF<40%, Stenosis, and Acute myocardial infarction are the risk factors of long term survival. There is significant difference in the subscales of SAQ between PCI group and Non-PCI group.ConclusionsPCI of intermediate LM lesions could help improve the survival rate numerically, but not statistically significant. PCI could also help relieve the angina symptoms and quality of life. We believe that it is reasonable to prefer PCI to medical therapies for intermediate LMCAD patients.Aging, smoking, Stroke history, Diabetes, EF<40%, and Acute myocardial infarction are the risk factors of long term survival. We suggest proper treatments for patients with the risk factors.