The Mortality in Left Main Stem Disease; A single-centre study from Pakistan


  • Abdul Wajid Khan Faisal Punjab Institute of Cardiology, Lahore, Pakistan
  • Naveed Ahmad Shahid Punjab Institute of Cardiology, Lahore, Pakistan
  • Ghalib Habib Punjab Institute of Cardiology, Lahore, Pakistan
  • Waqas Latif University of Health Sciences, Lahore, Pakistan
  • Sheeraz Ahmed Khan Punjab Institute of Cardiology, Lahore, Pakistan


Mortality, Left main stem, CABG, PCI, medical management



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.


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.


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.

Author Biographies

Abdul Wajid Khan Faisal, Punjab Institute of Cardiology, Lahore, Pakistan

Associate Professor of Cardiology

Naveed Ahmad Shahid, Punjab Institute of Cardiology, Lahore, Pakistan

Assistant Professor of Cardiology

Ghalib Habib, Punjab Institute of Cardiology, Lahore, Pakistan

Senior Registrar Cardiology

Waqas Latif, University of Health Sciences, Lahore, Pakistan

Bio Statistician

Sheeraz Ahmed Khan, Punjab Institute of Cardiology, Lahore, Pakistan

IT professional / Medical Transcriptor


Zalewska-Adamiec M, Bachórzewska-Gajewska H, Kralisz P, Nowak K, Hirnle T, Dobrzycki S. Prognosis in patients with left main coronary artery disease managed surgically, percutaneously or medically: a long-term follow-up. Kardiol Pol. 2013;71(8):787-95. doi: 10.5603/KP.2013.0189. PMID: 24049017.

Predescu LM, Zarma L, PlatonP, PostuM, BucsaA, Croitoru M, DeleanuDE,Ginghina C. Current treatment of left main coronary artery disease. Cor et Vasa 2016, 58(3):e328-e339 | DOI: 10.1016/j.crvasa.2015.05.007

Rahman MN, Hussain B, Artani A. Outcomes of Left Main Percutaneous Coronary Intervention. J Coll Physicians Surg Pak. 2019 Jun;29(6):498-501. doi: 10.29271/jcpsp.2019.06.498. PMID: 31133143.

Sher-I-Murtaza M, Baig MA, Raheel HM. Early outcome of Coronary Artery Bypass Graft Surgery in patients with significant Left Main Stem stenosis at a tertiary cardiac care center. Pak J Med Sci. 2015 Jul-Aug;31(4):909-14. doi: 10.12669/pjms.314.7597. PMID: 26430428; PMCID: PMC4590371.

Stone GW, Sabik JF, Serruys PW, Simonton CA, Généreux P, Puskas J, et al. Everolimus-eluting stents or bypass surgery forleft main coronary artery disease. N Engl J Med 2016; 375: 2223-35.

Avula HR, Rassi AN. The Current State of Left Main Percutaneous Coronary Intervention. CurrAtheroscler Rep. 2018 Jan 17;20(1):3. doi: 10.1007/s11883-018-0705-2. PMID: 29344756.

2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI).Authors/Task Force members., Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, WitkowskiA.Eur Heart J. 2014 Oct 1; 35(37):2541-619.

Shih M, Slovut D, Etkin Y, Lipsitz E. Left Main Coronary Artery Disease as a Predictor of Concomitant Carotid Artery Disease. J VascSurg.2012 SEPTEMBER 01;56( 3):895.

Faisal AWK, Iqbal MH, Haq S, Ali SA, Khan SA, Latif W. Gender difference and attributed risk factors in Left Main Stem Disease and its short term outcome. J Cardiovasc Dis 2020;16(4):130 – 134.

2018 ESC/EACTS Guidelines on myocardial revascularization.Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovi? PM, Sibbing D, StefaniniGG, Windecker S, Yadav R, ZembalaMO.EuroIntervention. 2019 Feb 20; 14(14):1435-1534.

Tra?c? SP, Goan?? EV, Târtea GC, Ciurea PL. The Impact of the Risk Factors in the Evolution of the Patients with Left Main Coronary Artery Stenosis Treated with PCI or CABG. Curr Health Sci J. 2019 Jan-Mar;45(1):19-27. doi: 10.12865/CHSJ.45.01.02. Epub 2019 Mar 31. PMID: 31297258; PMCID: PMC6592670.

2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR).

Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corrà U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FDR, Løchen ML, Löllgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, van der Worp HB, van Dis I, Verschuren WMM, Binno S, ESC Scientific Document Group. Eur Heart J. 2016 Aug 1; 37(29):2315-2381.

Ahmad Y, Howard JP, Arnold AD, Cook CM, Prasad M, Ali ZA, Parikh MA, Kosmidou I, Francis DP, Moses JW, Leon MB, Kirtane AJ, Stone GW, Karmpaliotis D. Mortality after drug-eluting stents vs. coronary artery bypass grafting for left main coronary artery disease: a meta-analysis of randomized controlled trials. Eur Heart J. 2020 Sep7;41(34):3228-3235. doi: 10.1093/eurheartj/ehaa135. PMID: 32118272; PMCID: PMC7557472.

Ramadan R, Boden WE, Kinlay S. Management of Left Main Coronary Artery Disease. J Am Heart Assoc. 2018 Mar 31;7(7):e008151. doi: 10.1161/JAHA.117.008151. PMID: 29605817; PMCID: PMC5907594.