Left main coronary artery stenosis: experience of 93 patients.

The clinical and angiographic findings in 93 consecutive cases of significant (greater than or equal to 50%) obstruction of the left main coronary artery were studied. This lesion was found in 6.85% of patients who underwent coronary arteriography. 93.5% of patients had presented with angina pectoris, of which 28% had unstable angina. There was one catheter-related death. Follow-up data were available in 90 cases, of which 23 were treated medically. Poor left ventricular function and significant right coronary artery disease adversely influenced the outcome in this group. 67 patients had aortocoronary saphenous vein bypass grafting. The operative mortality was 18% overall, but 36% in those undergoing emergency surgery (within 48 hours of catheterisation). Poor left ventricular function and electrocardiographic evidence of previous inferior myocardial infarction were associated with poor operative survival. The 55 survivors of surgery had an excellent prognosis with an annual attrition rate of 4% over two year follow-up period. 87% were asymptomatic at follow-up.