Clinical presentation and prognosis of left main coronary artery disease in the 1980s

Clinical presentation and course were studied in 127 consecutive patients with angiographically proven left main coronary artery disease. Mean age was 62 (37–79) years. Thirteen patients (10%) had no history of chest pain, seven (5%) had atypical chest pain, and the remaining 107 (85%) typical angina pectoris. Eighty-two patients (65%) had unstable angina, 73 had suffered a myocardial infarction (MI) in the past, and 50 (68%) had post MI angina pectoris. The electrocardiogram was analysed in 102/125 patients during an episode of chest pain and also when they were without chest pain. Outside an episode of chest pain the ST segment was normal in 42 patients (32% ), the T wave was normal in 50 patients (38%) and both the ST and T were normal in 33 patients (25%). During chest pain all patients had an abnormal ECG, the most frequent pattern being ST segment depression in leads V3, V4 and V5 (with maximal depression in V4), and ST segment elevation in leads VI and a VR. The average number of leads with ST-T abnormalities was 6.4. A symptom-limited exercise test on a treadmill with 12-lead ECG monitoring was performed in 89 patients. The exercise test was abnormal in 88 patients (99% ), most of whom (74 patients) were already in the first or second stage of the Bruce protocol. The most frequently observed abnormality was ST segment depression of 2 mm or more in leads V4, V5, and V6, and ST segment elevation in leads VI and a VR. The systolic blood pressure during exercise fell or remained at the same level in 38 patients (43%). One hundred patients (79%) underwent bypass surgery and 25 were treated medically. In the surgical group nine patients (9%) died at a mean follow-up of 28 months, five peroperatively. At last follow-up 78 patients were asymptomatic. In the medically treated group, eight patients (32%) died and only three were asymptomatic at a mean follow-up of 15 months. The surgical and medical group were not comparable however as to operability. We conclude that patients with left main stenosis have a good prognosis when treated surgically; surgery resulted in a marked improvement of symptoms. The prognosis of isolated left main coronary artery disease does not differ with or without additional one-, two-or three-vessel disease.