BACKGROUND: Left main disease (LMD) and three-vessel disease (3VD) have important prognostic value in patients with coronary artery disease. However, uncertainties still exist about their prevalence and predictors in patients with acute coronary syndrome (ACS) and also in patients with stable coronary disease. Thus the aim of this study was to perform an international collaborative systematic review and meta-analysis to appraise the prevalence and predictors of LMD and 3VD. METHODS: Medline/PubMed were systematically searched for eligible studies published up to 2010, reporting multivariate predictors of LMD or 3VD. Study features, patient characteristics, and prevalence and predictors of LMD and 3VD were abstracted and pooled with random-effect methods (95% CIs). RESULTS: 17 studies (22 740 patients) were included, 11 focusing on ACS (17 896 patients) and six on stable coronary disease (4844 patients). In the ACS subgroup, LMD or 3VD occurred in 20% (95% CI 7.2% to 33.4%), LMD in 12% (95% CI 10.5% to 13.5%), and 3VD in 25% (95% CI 23.1% to 27.0%). Heart failure at admission and extent of ST-segment elevation in lead aVR on 12-lead ECG were the most powerful predictors of LMD or 3VD. In the stable disease subgroup, LMD or 3VD was found in 36% (95% CI 18.5% to 48.8%), with the most powerful predictors being transient ischaemic dilation during the imaging stress test, extent of ST-segment elevation in aVR and V1 during the stress test, and hyperlipidaemia. CONCLUSIONS: This meta-analysis demonstrated that severe coronary disease-that is, LMD or 3VD-is more common in patients with ACS or stable coronary disease than generally perceived, and that simple and low-cost tools may help in the selection of the most appropriate therapeutic approach.
BACKGROUND: Left main disease (LMD) and three-vessel disease (3VD) have important prognostic value in patients with coronary artery disease. However, uncertainties still exist about their prevalence and predictors in patients with acute coronary syndrome (ACS) and also in patients with stable coronary disease. Thus the aim of this study was to perform an international collaborative systematic review and meta-analysis to appraise the prevalence and predictors of LMD and 3VD. METHODS: Medline/PubMed were systematically searched for eligible studies published up to 2010, reporting multivariate predictors of LMD or 3VD. Study features, patient characteristics, and prevalence and predictors of LMD and 3VD were abstracted and pooled with random-effect methods (95% CIs). RESULTS: 17 studies (22 740 patients) were included, 11 focusing on ACS (17 896 patients) and six on stable coronary disease (4844 patients). In the ACS subgroup, LMD or 3VD occurred in 20% (95% CI 7.2% to 33.4%), LMD in 12% (95% CI 10.5% to 13.5%), and 3VD in 25% (95% CI 23.1% to 27.0%). Heart failure at admission and extent of ST-segment elevation in lead aVR on 12-lead ECG were the most powerful predictors of LMD or 3VD. In the stable disease subgroup, LMD or 3VD was found in 36% (95% CI 18.5% to 48.8%), with the most powerful predictors being transient ischaemic dilation during the imaging stress test, extent of ST-segment elevation in aVR and V1 during the stress test, and hyperlipidaemia. CONCLUSIONS: This meta-analysis demonstrated that severe coronary disease-that is, LMD or 3VD-is more common in patients with ACS or stable coronary disease than generally perceived, and that simple and low-cost tools may help in the selection of the most appropriate therapeutic approach.
Authors: Flavia Ballocca; Fabrizio D'Ascenzo; Claudio Moretti; Roberto Diletti; Carlo Budano; Alberto Palazzuoli; Matthew J Reed; Tullio Palmerini; Dariusz Dudek; Alfredo Galassi; Pierluigi Omedè; Nicolas M Mieghem; David Ferenbach; Marco Pavani; Diego Della Riva; Nick L Mills; Ron T Van Domburgh; Andrea Mariani; Artur Dziewierz; Marco di Cuia; Robert Jan van Geuns; Felix Zijlstra; Serena Bergerone; Sebastiano Marra; Giuseppe Biondi Zoccai; Fiorenzo Gaita Journal: Cardiol J Date: 2017-03-10 Impact factor: 2.737
Authors: Fabrizio D'Ascenzo; Ovidio De Filippo; Edoardo Elia; Mattia Paolo Doronzo; Pierluigi Omedè; Antonio Montefusco; Mauro Pennone; Stefano Salizzoni; Federico Conrotto; Guglielmo Gallone; Filippo Angelini; Luca Franchin; Francesco Bruno; Massimo Boffini; Mario Gaudino; Mauro Rinaldi; Gaetano Maria De Ferrari Journal: Eur Heart J Qual Care Clin Outcomes Date: 2021-09-16
Authors: Ulf Neisius; Thomas Koeck; Harald Mischak; Sabrina H Rossi; Erin Olson; David M Carty; Jane A Dymott; Anna F Dominiczak; Colin Berry; Keith G Oldroyd; Christian Delles Journal: BMC Cardiovasc Disord Date: 2016-04-19 Impact factor: 2.298