HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Anders Jönsson Torbjörn Ivert Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Jönsson, A. Articles by Ivert, T. Search for Related Content PubMed PubMed Citation Articles by Jönsson, A. Articles by Ivert, T. Related Collections Coronary disease

Eur J Cardiothorac Surg 2006;30:311-317
© 2006 Elsevier Science NL

Left main coronary artery stenosis no longer a risk factor for early and late death after coronary artery bypass surgery — an experience covering three decades

^a Department of Thoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
^b Department of Epidemiology; Institute of Environmental Medicine, Sweden
^c Department of Epidemiology, AstraZeneca R&D, Mölndal, Sweden
^d Department of Epidemiology, Stockholm Centre of Public Health, Stockholm, Sweden

Received 21 March 2006; accepted 15 May 2006.

^_* Corresponding author. Address: Department of Cardiothoracic Surgery, Karolinska University Hospital, S-171 76 Stockholm, Sweden. Tel.: +46 8 517 70832; fax: +46 8 331931. (Email: anders.l.jonsson{at}karolinska.se).

Objective: To analyse early and late mortality after coronary artery bypass grafting (CABG) in patients with and without left main coronary artery (LMCA) stenosis during the 30-year period 1970–1999. Methods: A total of 1888 of 10,647 patients (18%) who underwent a first isolated CABG at the Karolinska Hospital in Stockholm, Sweden, during 1970–1999 had significant left main coronary artery stenosis. The Swedish National Cause of Death Register was used to determine mortality up to five years after the operation. Results: The proportion of patients with LMCA stenosis of all CABG patients increased from 7% during the 1970s to 26% in 1999. During 1970–1984 early mortality was 5.8% in patients with LMCA stenosis compared with 1.5% in patients without LMCA stenosis (odds ratio (OR) 3.7 (95% confidence interval (CI) 1.8–7.6)). The corresponding rates during 1995–1999 were 2.0% versus 2.2% (OR 0.8 (95% CI 0.5–1.5)), respectively. The increased risk of early death in patients with LMCA stenosis was neutralised in males during 1985–1994 and in females during 1995–1999. Five-year survival in males was 88% after operations performed during 1994–1999 compared with 82% after CABG performed during 1970–1984. Five-year mortality, exclusive of early deaths, during 1970–1984 was higher in patients with LMCA stenosis (12.8%) than in those without (8.4%) (relative risk 1.7 (95% CI 1.1–2.5)). An increased risk of late mortality in patients with LMCA stenosis was neutralised in males during 1985–1994 and in females during 1995–1999. Conclusions: During 1970–1999 there was a decrease of early and five-year mortality in patients with LMCA stenosis after CABG despite increase of patient age and risk factors. There were gender differences so that the risk of death in patients with compared with in those without LMCA stenosis was neutralised in males during 1985–1994 and in females during 1994–1999. The continuous decline of mortality during three decades most likely reflects improvement of the peri- and postoperative management of patients undergoing CABG during this period.

Key Words: Left main coronary artery • Mortality • Coronary artery bypass grafting

This article has been cited by other articles:

				J. Mehilli, A. Kastrati, R. A. Byrne, O. Bruskina, R. Iijima, S. Schulz, J. Pache, M. Seyfarth, S. Massberg, K.-L. Laugwitz, et al. Paclitaxel- Versus Sirolimus-Eluting Stents for Unprotected Left Main Coronary Artery Disease J. Am. Coll. Cardiol., May 12, 2009; 53(19): 1760 - 1768. [Abstract] [Full Text] [PDF]

				R. J. Shemin Coronary Artery Bypass Grafting Versus Stenting for Unprotected Left Main Coronary Artery Disease: Where Lies the Body of Proof? Circulation, December 2, 2008; 118(23): 2326 - 2329. [Full Text] [PDF]

				P. G. Malvindi, J. Dunning, and N. Vitale For which patients with left main stem disease is percutaneous intervention rather than coronary artery bypass grafting the better option? Interactive CardioVascular and Thoracic Surgery, April 1, 2008; 7(2): 306 - 314. [Abstract] [Full Text] [PDF]

				D. P. Taggart, S. Kaul, W. E. Boden, T. B. Ferguson Jr, R. A. Guyton, M. J. Mack, P. T. Sergeant, R. J. Shemin, P. K. Smith, and S. Yusuf Revascularization for unprotected left main stem coronary artery stenosis stenting or surgery. J. Am. Coll. Cardiol., March 4, 2008; 51(9): 885 - 892. [Abstract] [Full Text] [PDF]