In medically treated patients, left main stenosis of 50-70% is associated with significantly better survival compared to stenosis of 70% or greater, highlighting the importance of severity and noninvasive risk descriptors in prognostic stratification.
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Severity stratifies survival in medically treated left main stenosis; leaves open whether intervention thresholds warrant refinement in randomized trials.
Three-year survival for 163 consecutive medically treated patients with 50% or greater left main stenosis was 50%. Survival was significantly higher for patients with 50 to 70% left main stenosis (one and three-year survivals of 91% and 66%) than for patients with 70% or greater left main stenosis (one and three-year survivals of 72% and 41%). In fact, left main lesions of less than 70% were not associated with the increased risk usually attributed to patients with left main stenosis. A number of noninvasive and catheterization characteristics were significant predictors of survival for patients with 70% or greater left main stenosis. Noninvasive descriptors defined a low risk subgroup (one and three-year survivals of 97% and 74%) and a high risk subgroup (one- and three-year survivals of 59% and 25%). These observations have important implications both in assessing therapeutic interventions and in managing individual patients.
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Conley et al. (1978) studied this question.
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