Optimal treatment for left main coronary artery disease based on the Gensini score

<ns3:p>BACKGROUND: The severity of atherosclerosis in the coronary arteries significantly impacts cardiovascular outcomes. Maintaining adequate blood flow in the left main coronary artery (LMCA) is crucial for myocardial perfusion. Comparative studies of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with multivessel coronary artery disease indicate that CABG is associated with lower mortality rates. A specific subset of patients is those with significant stenosis of the LMCA, for whom surgical treatment is standard, but patients with less complex stenoses in the coronary arteries may also benefit from PCI. The choice of treatment method for LMCA disease should be based on assessing the atherosclerosis severity using indices such as Gensini or SYNTAX scores, which help predict the effectiveness of revascularisation and enable the prediction of adverse cardiovascular events.AIMS: The study analyses early and long-term mortality in patients with LMCA disease who underwent coronary angiography and were treated percutaneously or surgically based on the Gensini score (GS).METHODS: We retrospectively reviewed 249 patients with LMCA disease who underwent coronary angiography between 2000 and 2004, of whom 11% were scheduled for LMCA PCI and 89% for CABG. The GS was calculated based on the degree of coronary artery stenosis, patients were cathegorised into three groups (group I with GS < 58, group II with GS = 58-94, group III with GS > 94). Patients hospitalised for chronic coronary syndrome, unstable angina, or myocardial infarction were included in the study.RESULTS: Within the analysed groups, patients with chronic coronary syndrome were more frequently selected for CABG, and patients with myocardial infarction for LMCA PCI. The prevalence of atherosclerosis risk factors did not affect the treatment strategy. Significant stenosis in the LMCA orifice and the middle segment was more often treated with angioplasty (p = 0.005). In contrast, patients with stenosis in the distal segment were more commonly referred for CABG (p = 0.015). It was found that in groups II and III, 30-day mortality was higher after LMCA PCI (II – p = 0.005, III – p = 0.036), which persisted during the 5-year follow-up (II – p = 0.032, III – p = 0.048). In group I, no differences in short- and long-term mortality were observed between LMCA PCI and CABG. After 10 years of follow-up, 12 patients (43%) died after LMCA PCI, including 6 within 30 days after the procedure.CONCLUSIONS: Mortality risk is closely associated with the GS value and the chosen revascularisation method. Angiographic assessment of coronary arteries using the GS is essential for prognosis and treatment strategy selection. The subset of patients with severe LMCA stenosis and GS < 58 can safely undergo LMCA PCI. The simple and easy-accessible GS may be helpful in routine clinical practice.</ns3:p>