The Mortality in Left Main Stem Disease; A single-centre study from Pakistan
Keywords:
Mortality, Left main stem, CABG, PCI, medical managementAbstract
Background
Left main stem (LMS) disease carries a special consideration as it supplies the major part of myocardium. It carries a very high mortality that is around 15 % in 15 months follow up. Patients managed medically have highest mortality followed by percutaneous intervention (PCI) and then coronary artery bypass grafting (CABG).
Aims and Objectives:
In order to know about the actual fate of our patients having LMS disease, we conducted the study specially the patients who do not undergo CABG the gold standard management for these patients.
Results:
Out of 112 patients 89 patients completed follow up. Among these 76 (85.4%) were male patients, 13 (14.6%) were females. Fifty seven patients underwent CABG, 03 patients had PCI while 29 patients remained on medical management. All patients had moderate to severe LMS stenosis with or without involvement of other coronary arteries. One patient had clot in LMS. Majority of patients had distal involvement of LMS i.e. 70 patients (78.7%). Hypertension was the most common underlying risk factor 50 patients (56.2%) followed by Diabetes 42.7% and smoking 38.2%. Out of 89 patients, 22(24.7%) patients died during the study period. Mortality was 13(23%) amongst CABG group and 9 (31%) amongst medically treated patients. The PCI group was very small to confer any significance comprising 3 patients only. Result indicated that the higher mortality rate was observed in patients who were managed medically followed by CABG. The p-value of 0.532 indicates that the difference was insignificant.
Conclusion:
The left main stem disease carries a very high mortality. CABG is superior to the medical management as already known but it lacks statistically significance in our population. The mortality remains high whatever the management you opt.
Key words: Mortality, Left main stem, CABG, PCI, medical management.
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