A life table and Cox regression analysis of patients with combined proximal left anterior descending and proximal left circumflex coronary artery disease: Non-left main equivalent lesions (CASS)

Academic Article

Abstract

  • Combined proximal left anterior descending and proximal left circumflex artery stenoses ≥70% have been referred to as 'left main equivalent' lesions. We compared the survival rates of medically treated patients who have this type of coronary anatomic characteristics with the survival rates of patients who have left main coronary artery stenoses ≥70% by use of a stratified life table approach and a Cox regression model. Comparison of the patients with left main coronary artery stenoses with those who have left main equivalent lesions by use of life table analysis and three different calculations of patient exposure time revealed a poorer prognosis for the patients who had left main coronary artery disease (p ≤.04 for all three methods). The stepwise Cox analysis also determined that patients who had left main artery stenoses had a significantly poorer prognosis than patients who had left main equivalent coronary disease (p = .002), even after consideration of important baseline variables known to affect survival rates. We then compared the patients who had combined proximal left anterior descending and proximal left circumflex artery disease with patients who had combined stenoses ≥70% in the nonproximal left anterior descending and proximal circumflex coronary arteries to determine if location of the left anterior descending stenosis influenced survival rates. The 5-year survival rate was not as high for the patients who had proximal left anterior descending artery disease (55% vs 70%, p = .001). In conclusion, combined proximal left anterior descending and proximal left circumflex artery disease identifies a high-risk (as determined by angiography) patient subset. It is not, however, prognostically equivalent to left main coronary artery disease.
  • Authors

    Published In

  • Circulation  Journal
  • Digital Object Identifier (doi)

    Author List

  • Chaitman BR; Davis K; Fisher LD; Bourassa MG; Mock MB; Lespérance J; Rogers WJ; Fray D; Tyras DH; Judkins MP
  • Start Page

  • 1163
  • End Page

  • 1170
  • Volume

  • 68
  • Issue

  • 6