GENDER DIFFERENCE AND ATTRIBUTED RISK FACTORS IN LEFT MAIN STEM DISEASE AND ITS SHORT TERM OUTCOME

Abstract

ABSTRACT

BACKGROUND: Coronary artery disease (CAD) is one of the leading causes of death worldwide. Among CAD left main stem (LMS) disease is a major cause of cardiovascular morbidity and mortality in both genders. Atherosclerosis is the major cause of LMS disease. Coronary Artery Bypass Grafting (CABG) is considered as the mainstay of treatment other than evidence based optimal medical therapy. But in the past two decades due to advancements in the patient selection criteria and intravascular imaging, Percutaneous Coronary Intervention (PCI) is one of the effective treatment option.

OBJECTIVE:To determine the frequency of left main stem disease in both genders, in different age groups and to look for major attributed risk factors and outcome of disease on short term follow up.

MATERIAL AND METHODS: It is a descriptive observational study conducted in the department of cardiac catheterization, Punjab Institute of Cardiology, Lahore. Over the period of six month from Jan 1st to 30th June 2020. Patients with left main stem disease having 50% or more stenosis were included in the study. More than 70% stenosis was taken as severe LMS disease. Patients with normal left main stem or having less than 50% stenosis were excluded. Patients were followed up from hospital record and or telephonic communication and assessed for risk factors and outcome i.e, death on short term follow up minimum till the hospital discharge and maximum upto 8 months.

RESULTS: Out of total 5127 patients, prevalence LMS disease was seen in 3.5% (179) patients, male were 149(83.2%), female were 30(16.8%). Mean age of male patients was 57.4 ± 10.7 years(min.26, max 94), female 56.97± 9.6 years (min.33,max 75). Severe left main disease was present in 84(47%) patients i.e. male 74(49.7%) and female 10(33, 3%).While patients with moderate disease were 94(52.5%) i.e. male 74 (49.7%) and female 20 (66.7%). Distal LMS disease was present in 138(77%) patients, males were 114(76.5%) and female 24(80.0%),while ostial LMS was present in only 32(17.8%),male 27(18.1%) and female  5(16.7%). Risk factors and outcome data of only 112/179 patients was available.  Hypertension was present in 63(56.25%) i.e. 49( 52.7% )male and female 14( 73.7%) with p value =0.226.

45 patients were found to be diabetic (40.2%) out of which 37(39.8%) were male and 8 were female (42.1%)] with p value =0.879.  A total number of 43(38.4%) were smoker, male 42(45.2%) and only 1female (5.3%) [p value=0.001. Positive family history was present in 24(21.4%)[male21(22.6%) and female3(15.8%)] (p value=0.760). Hyperlipidemia was present in 13(11.6%), [male12 (13.0%), female 1(5.6%)], p value=0.691. Isolated LMS was present in 2 female patients, all male patients had LMS disease along with other vessel/vessels involvement. 46 males and 10  females underwent CABG. PCI was done in 4 patients male 3 and  1 female. On follow up total number of 13 patients, male 10 and female 3 expired including 8 (14.3%) post operatively 7(15.2%) male and 1(10%) female.

CONCLUSION:LMS disease with other coronary artery involvement is more common in males and isolated LMS is seen in females only. It has very high mortality rates. Hypertension is a major risk factor of LMS disease in both genders, while smoking is a major risk in male patients.

KEY WORDS: Left main stem disease, gender, outcome, Coronary artery bypass grafting.