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2011, vol. 17, br. 1-2, str. 17-27
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Kliničke karakteristike i mortalitet bolesnika sa oboljenjem glavnog stabla leve koronarne arterije i njihova učestalost u populaciji bolesnika sa koronarnom bolešću
Clinical characteristics and mortality of patients with disease of the left main coronary artery and its prevalence in patients with coronary artery disease
Sažetak
Uvod. Stenoza glavnog stabla leve koronarne arterije (engl. left main coronary artery - LMCA) je relativno redak, ali važan uzrok koronarne bolesti i nezavisan pokazatelj povećanog morbiditeta i mortaliteta bolesnika sa koronarnom bolešću. Cilj rada. Ispitivani su prevalencija, kliničke karakteristike i mortalitet bolesnika sa značajnom (>50%) stenozom glavnog stabla leve koronarne arterije u bolesnika sa koronarnom bolešću. Metod. Ispitivanjem je obuhvaćeno 156 bolesnika sa koronarnom bolešću, 114 (73,1%) muškaraca i 42 (26,9%) žene, prosečne starosti 56,2±5,1 godina. Sa prebolelim infarktom miokarda (IM) bilo je 93 (59,6%), nestabilnom anginom pektoris (NAP) 24 (15,4%) i stabilnom anginom (SAP) 39 (25,0%) bolesnika. Kod svih bolesnika primenjeno je prospektivno ispitivanje, selektivna koronarografija, klinički pregled, stalana EKG kontrola, laboratorijska, rendgenska i ehokardiografska dijagnostika. Svi bolesnici su praćeni prosečno 5 godina - sa oboljenjem LMCA 4,1 god., bez oboljenja LMCA 4,9 god. i sa stenozom jednog ili više sudova 5,2 godine. Kompletno kardiološko i hemodinamsko ispitivanje i revaskularizacija miokarda aortokoronarnim bajpasom (CABG) ili perkutanom koronarnom intervencijom (PCI), obavljeni su u Institutu za kardiovaskularne bolesti Kliničkog centra Srbije (KCS) i Institutu za kardiovaskularne bolesti ''Dedinje'' u Beogradu. Rezultati. Značajna stenoza LMCA nađena je kod 12/156 (7,7%) bolesnika, 8/12 (66,7%) muškaraca i 4/12 (33,3%) žene, prosečne starosti 55,9±7,7 godina, a izolovana stenoza LMCA kod 2/156 (1,3%) bolesnika. Bolest LMCA nađena je kod 6/93 (6,5%) bolesnika sa IM, 4/24 (16,7%) bolesnika sa NAP i kod 2/39 (5,1%) bolesnika sa SAP. Stenoza LMCA je postojala kod 12/117 (10,3%) bolesnika sa revaskularizacijom miokarda, kod 11/65 (16,9%) sa CABG i kod 1/52 (1,9%) bolesnika sa PCI. Mortalitet bolesnika sa oboljenjem LMCA je 6,1% godišnje, mortalitet bolesnika bez oboljenja LMCA 3,1%, bolesnika sa jednosudovnom, dvosudovnom i trosudovnom bolešću bez oboljenja LMCA 2,8%, sa oboljnjem LMCA 3,4% godišnje, a mortalitet bolesnika sa koronarnom Zaključak. Učestalost značajne stenoze LMCA u bolesnika sa koronarnom bolešću je 7,7%, a mortalitet 6,1% godišnje. Veći mortalitet bolesnika sa oboljenjem glavnog stabla leve koronarne arterije u odnosu na bolesnike sa koronarnom bolešću bez značajne stenoze, ukazuje da je signifikantna stenoza glavnog stabla lezija visokog rizika i faktor povećanog mortaliteta ovih bolesnika.
Abstract
Introduction. Left main coronary artery (LMCA) stenosis is relatively infrequent but important cause of symptomatic coronary artery disease. Multiple studies have found LMCA stenosis to be an independent indicator of increased morbidity and mortality rates among patients with coronary artery disease. Objective. To ascertain prevalence, clinical characteristics and mortality in patients with significant (>50%) stenosis of the left main coronary artery in patients with coronary disease. Method. The study included 156 patients with coronary artery disease,114 (73,1%) males and 42 (26,9%) women , mean age 56,2±5,1 years. Study comprised 93 (59,6%) patients with myocardial infarction, 24 (15,4%) with unstable angina pectoris and 39 (25%) with stable angina pectoris. All patient underwent clinical examination, continuous EKG control, laboratory, chest X-ray, echocardiography and selective coronarography. Average follow-up for all patients was 5 years (4,1 years for patients with LMCA disease, 4,9 years for patients without LMCA disease, and 5,2 years for patients with stenosis of one, two or three coronary arteries. Results. Significant (>50%) LMCA stenosis was present in 12 (7,7%) patients, average age of 55,9±7,7 years, 8 male and 4 female. Isolated LMCA stenosis persisted in 2 (1,3%) patients. In group of 93 patients with myocardial infarction, LMCA stenosis was found in 6 (6.5%), in group of 24 patients with unstable angina pectoris in 4 (16.7%), and in group of 39 patients with stable angina pectoris in 2 (5.1%). LMCA stenosis was found in 12 of 117 patients who underwent myocardial revascularization (10.3%), in 11 of 65 patients with CABG (16,9%) and in 1 of 52 patients with PCI (1.9%). Mortality rate per year for patients with LMCA stenosis was 6,1%, for patients without LMCA stenosis 3,1%, for patients with one , two and three vessel disease, without LMCA stenosis 2,8% and for those with one , two and three vessel disease, with LMCA stenosis 3,4%. Mortality rate per year for patients with coronary disease without significant stenosis was 1,3%. Conclusion. Prevalence of significant LMCA stenosis LMCA stenosis in patients with coronary artery disease is 7,7% and mortality per year equals 6,1%. Higher mortality in patients with LMCA stenosis in relation to patients with coronary disease without significant LMCA stenosis indicates that the significant LMCA stenosis is a high-risk lesion associated wit high mortality rate in those patients.
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