Severe Left Main Coronary Artery Stenosis as the First Finding in Newly Diagnosed Chronic Coronary Syndrome: Incidence and Clinical Predictors

Abstract

Severe left main coronary artery (LMCA) lesions (≥50% stenosis) portend a poor prognosis and require urgent revascularization. In this study, we identified the incidence and clinical predictors of severe LMCA stenosis in patients with chronic coronary syndrome (CCS) who had undergone coronary angiography for the first time. Using a nationwide database registry, all the patients with CCS who had undergone coronary angiography were included. Patients were classified based on having severe LMCA stenosis and they were compared based on the recommended therapeutic strategy after angiography. A multivariable binary logistic regression model was developed to identify the potential predictors of a severe LMCA lesion. Among 40,161 patients with CCS, a severe LMCA lesion was detected in a total of 1556 participants (3.87% [3.69; 6.07]). The multivariable logistic regression identified age (odds ratio [OR]: 1.04 [1.03;1.04]), male gender (OR:2.56 [2.28; 2.89]), dyslipidemia (OR:1.19 [1.06; 1.34]), and peripheral arterial disease (PAD) (OR:3.68 [1.06;12.83]) as predictors of a severe LMCA stenosis. Approximately 4% of patients with newly diagnosed CCS may suffer from severe LMCA disease. Age, male gender, dyslipidemia, and PAD are among the predicting factors of a severe LMCA stenosis and can be utilized in risk stratification of patients with CCS at greater risk of severe LMCA stenosis.

Keywords: chronic coronary syndrome; coronary artery bypass grafting; left main coronary artery; percutaneous coronary intervention; stable coronary artery disease.