Circulation, Vol 79, 1171-1179, Copyright © 1989 by American Heart Association
HA Taylor, NJ Deumite, BR Chaitman, KB Davis, T Killip and WJ Rogers
Left main coronary artery disease (i.e., greater than or equal to 50%
stenosis) was found in 1,477 of 20,137 patients in the Coronary Artery
Surgery Study (CAS) registry. Of these patients, 53 (3.6%) were
asymptomatic. Asymptomatic and symptomatic patients were similar in regard
to 1) severity of left main coronary artery stenosis (67% vs. 70%), 2)
extent of proximal coronary artery disease (no differences in number of or
severity of proximal stenoses), 3) left ventricular end- diastolic pressure
(13 mm Hg vs. 14 mm Hg), 4) left ventricular wall motion score 9.1 vs.
8.7), and 5) number of coronary artery segments with greater than 70%
stenosis (4.4 vs. 4.8). Among the asymptomatic patients, 47% received
medical and 49% received surgical treatment. In the symptomatic group, 20%
received medical and 78% received surgical therapy. The survival rate 5
years after surgery for treatment of left main coronary artery stenosis was
84% for the symptomatic patients and 88% for the asymptomatic patients (p =
NS). Medical management of left main coronary artery disease produced a
5-year survival rate of 57% for asymptomatic patients and 58% for
symptomatic patients. Within the asymptomatic subgroup, 88% of those
surgically treated survived 5 years, whereas only 57% of those medically
treated survived 5 years (p = 0.02). Thus, for CASS patients with left main
coronary artery disease, the percentage of those that were asymptomatic is
low (3.6%); asymptomatic and symptomatic patients with left main coronary
artery disease had no significant difference in severity of left main
coronary artery stenosis, extent of overall coronary artery disease, or
left ventricular function.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Asymptomatic left main coronary artery disease in the Coronary Artery Surgery Study (CASS) registry
Department of Medicine, University of Alabama Medical Center, Birmingham 35294.
This article has been cited by other articles:
 |
|
 |
|
  M. Hamilos, O. Muller, T. Cuisset, A. Ntalianis, G. Chlouverakis, G. Sarno, O. Nelis, J. Bartunek, M. Vanderheyden, E. Wyffels, et al. Long-Term Clinical Outcome After Fractional Flow Reserve-Guided Treatment in Patients With Angiographically Equivocal Left Main Coronary Artery Stenosis Circulation, October 13, 2009; 120(15): 1505 - 1512. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Naik, A. J. White, T. Chakravarty, J. Forrester, G. Fontana, S. Kar, P. K. Shah, R. E. Weiss, and R. Makkar A Meta-Analysis of 3,773 Patients Treated With Percutaneous Coronary Intervention or Surgery for Unprotected Left Main Coronary Artery Stenosis J. Am. Coll. Cardiol. Intv., August 1, 2009; 2(8): 739 - 747. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. R. Smith Surgery, Not Percutaneous Revascularization, Is the Preferred Strategy for Patients With Significant Left Main Coronary Stenosis Circulation, February 24, 2009; 119(7): 1013 - 1020. [Full Text] [PDF]
|
|
|
|
|
|
G. T. Gyenes and W. A. Ghali Should All Patients With Asymptomatic but Significant (>50%) Left Main Coronary Artery Stenosis Undergo Surgical Revascularization? Circulation, July 22, 2008; 118(4): 422 - 425. [Full Text] [PDF]
|
|
|
|
|
|
A. J. White, G. Kedia, J. M. Mirocha, M. S. Lee, J. S. Forrester, W. C. Morales, S. Dohad, S. Kar, L. S. Czer, G. P. Fontana, et al. Comparison of Coronary Artery Bypass Surgery and Percutaneous Drug-Eluting Stent Implantation for Treatment of Left Main Coronary Artery Stenosis J. Am. Coll. Cardiol. Intv., June 1, 2008; 1(3): 236 - 245. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. A. Heidenreich, I. Schnittger, H. W. Strauss, R. H. Vagelos, B. K. Lee, C. S. Mariscal, D. J. Tate, S. J. Horning, R. T. Hoppe, and S. L. Hancock Screening for Coronary Artery Disease After Mediastinal Irradiation for Hodgkin's Disease J. Clin. Oncol., January 1, 2007; 25(1): 43 - 49. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Mahajan, G. Hollander, B. Malik, B. Temple, D. Thekkoott, S. Abrol, N. Schulhoff, J. Ghosh, J. Shani, and E. Lichstein Isolated and Significant Left Main Coronary Artery Disease: Demographics, Hemodynamics and Angiographic Features Angiology, August 1, 2006; 57(4): 464 - 477. [Abstract] [PDF]
|
|
|
|
 |
|
 M. S. Lee, N. Kapoor, F. Jamal, L. Czer, J. Aragon, J. Forrester, S. Kar, S. Dohad, R. Kass, N. Eigler, et al. Comparison of Coronary Artery Bypass Surgery With Percutaneous Coronary Intervention With Drug-Eluting Stents for Unprotected Left Main Coronary Artery Disease J. Am. Coll. Cardiol., February 21, 2006; 47(4): 864 - 870. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. H. Marwick, C. Case, D. Poldermans, E. Boersma, J. Bax, S. Sawada, and J. D. Thomas A clinical and echocardiographic score for assigning risk of major events after dobutamine echocardiograms J. Am. Coll. Cardiol., June 2, 2004; 43(11): 2102 - 2107. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Gibbons, J. Abrams, K. Chatterjee, J. Daley, P. C. Deedwania, J. S. Douglas, T. B. Ferguson Jr, S. D. Fihn, T. D. Fraker Jr, J. M. Gardin, et al. ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina) Circulation, January 7, 2003; 107(1): 149 - 158. [Full Text] [PDF]
|
|
|
|
|
|
Committee Members, R. J. Gibbons, J. Abrams, K. Chatterjee, J. Daley, P. C. Deedwania, J. S. Douglas, T. B. Ferguson Jr, S. D. Fihn, T. D. Fraker Jr, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on the Management of Patients With Chronic Stable Angina) J. Am. Coll. Cardiol., January 1, 2003; 41(1): 159 - 168. [Full Text] [PDF]
|
|
|
|
|
|
K. A. Eagle, R. A. Guyton, R. Davidoff, G. A. Ewy, J. Fonger, T. J. Gardner, J. P. Gott, H. C. Herrmann, R. A. Marlow, W. C. Nugent, et al. ACC/AHA guidelines for coronary artery bypass graft surgery: A report of the American College of Cardiology/ American Heart Association task force on Practice Guidelines (Committee to revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery) J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1262 - 1347. [Full Text] [PDF]
|
|
|
|
|
|
A. S. Abizaid, G. S. Mintz, A. Abizaid, R. Mehran, A. J. Lansky, A. D. Pichard, L. F. Satler, H. Wu, K. M. Kent, and M. B. Leon One-year follow-up after intravascular ultrasound assessment of moderate left main coronary artery disease in patients with ambiguous angiograms J. Am. Coll. Cardiol., September 1, 1999; 34(3): 707 - 715. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Magovern, D. H. Benckart, R. J. Landreneau, T. Sakert, and G. J. Magovern Jr Morbidity, cost, and six-month outcome of minimally invasive direct coronary artery bypass grafting Ann. Thorac. Surg., October 1, 1998; 66(4): 1224 - 1229. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. A. Caracciolo, K. B. Davis, G. Sopko, G. C. Kaiser, S. D. Corley, H. Schaff, H. A. Taylor, and B. R. Chaitman Comparison of Surgical and Medical Group Survival in Patients With Left Main Coronary Artery Disease : Long-term CASS Experience Circulation, May 1, 1995; 91(9): 2325 - 2334. [Abstract] [Full Text]
|
|
|
|
 |
|
 O. N. Nwasokwa, J. H. Koss, G. H. Friedman, A. M. Grunwald, and M. M. Bodenheimer Bypass Surgery for Chronic Stable Angina: Predictors of Survival Benefit and Strategy for Patient Selection Ann Intern Med, June 1, 1991; 114(12): 1035 - 1049. [Abstract] [PDF]
|
|
|
|
|
|
R. M. Gunnar Decision Analysis in the Evaluation of Revascularization Ann Intern Med, December 1, 1990; 113(11): 817 - 818. [Abstract] [PDF]
|
|
|
|
 |
|
 MEDICAL THERAPY INADEQUATE FOR LEFT MAIN CAD Journal Watch (General), June 30, 1989; 1989(630): 3 - 3. [Full Text]
|
|