Key result
Isolated LMCA ostial disease predominates in middle-aged females but shows no difference in 1-year mortality.
Why the study?
Isolated LMCA ostial disease is a rare variant with limited prior studies due to small patient numbers, necessitating analysis of its incidence, risk factors, clinical profile, and long-term outcomes.
Do patients with isolated LMCA ostial disease have different clinical profiles and outcomes compared to those with non-ostial/non-isolated LMCA disease?
Observational (n=351)
No
Do patients with isolated LMCA ostial disease have different clinical profiles and outcomes compared to those with non-ostial/non-isolated LMCA disease?
p-value: p=0.234
Isolated LMCA ostial disease is a distinct clinical entity more common in middle-aged females with fewer traditional risk factors, but carries a similar 1-year mortality risk to other forms of LMCA disease.
Isolated LMCA ostial disease may warrant similar risk stratification as other forms; leaves open prospective validation of phenotype-specific therapies.
OBJECTIVES: Isolated left main coronary artery (LMCA) ostial disease is a rare variant of LMCA disease. Earlier studies on this disease are limited by small number of patients enrolled. The aim of the present study was to analyze the incidence, risk factors, clinical profile and long term outcome of patients with isolated LMCA ostial disease. METHODS: 15,553 patients who underwent coronary angiogram in a single tertiary care cardiac hospital were analyzed for LMCA disease. 351(2.2%) patients were found to have significant LMCA disease out of which 28(0.18%) had isolated LMCA ostial disease. These 28 patients were compared with 323 non-ostial and non-isolated LMCA disease patients. RESULTS: The mean age of isolated LMCA ostial disease group was significantly less than the other group (p=0.009). Females were more affected than males (p=0.008). They also had low incidence of coronary risk factors (especially dyslipidemia, p=0.04). They tend to present more with stable angina and less with myocardial infarction. They had higher ejection fraction and normal regional wall motion (p=0.04). There was no mortality difference between two groups at the end of 1 year (p=0.234). CONCLUSION: In one of the largest studies done in these patients, we found that isolated LMCA ostial disease is more common in middle aged females with few coronary risk factors. These patients also had a better ejection fraction and normal regional wall motion compared to patients with non-ostial and non-isolated LMCA disease. The clinical and angiographic profile of these patients suggests that they may represent a distinct clinical entity.
No takes yet. Share an insight, caveat, or question.
Srinivas et al. (2017) conducted an observational in Left main coronary artery (LMCA) disease (n=351). Isolated LMCA ostial disease vs. Non-ostial and non-isolated LMCA disease was evaluated on Mortality at 1 year (p=0.234). Isolated LMCA ostial disease was more common in middle-aged females with fewer risk factors and better ejection fraction, with no significant difference in 1-year mortality (p=0.234).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: