SIGNIFICANT LEFT MAIN CORONARY-ARTERY DIS EASE - A RETROSPECTIVE STUDY OF 227 CASES

Significant left main coronary artery disease is a separate disease en tity in coronary artery disease. The prognosis is classically poor and the treatment of choice is surgical. A retrospective study of patient s with left main coronary disease, diagnosed and treated at the CHRU D upuytren, Limoges, between 1/01/80 and 15/06/91 was undertaken to dete rmine the aetiological, clinical and therapeutic factors which influen ce mortality related to this condition. During this period, 8198 coron ary angiographies were performed in the cardiology department. The dia gnosis of significant left main coronary disease (greater-than-or-equa l-to 50 % stenosis) was made in 250 cases (3 % of all investigations). Of these 250 cases, 227 were treated medically or surgically by our g roupe during the study period. Twenty patients were treated in another centre and 3 underwent surgery after the 15/06/91. Seven patients die d in the period immediately after coronary angiography. Of the 220 sur vivors of coronary angiography, 185 (85 %) were referred for surgery ( direct or sequential venous and/or arterial bypass or coronary endarte riectomy). Four patients died within 30 days of surgery. Thirty five p atients were treated medically. The therapeutic decision was based on the absence of surgical contra-indications. The retrospective, non-ran domized nature of this study with allocation of patients to surgical o r medical treatment without control invalidated statistical analysis. At the date of the last follow-up appointment, arbitrarily chosen as t he 1/01/93, 163 operated patients (88.1 %) of which 130 (79.7 %) were asymptomatic and 13 medically treated patients (37 %) were alive. The prognostic factors after surgery in this study were : stage IV dyspnoe a at the time of diagnosis, severe abnormalities on catheter study (en d diastolic pressure over 18 mmHg after angiography), left ventricular wall abnormalities (functional score > 10) and incomplete revasculari zation. The risk of coronary angiography in this condition were confir med in this study.