Concomitant presence of subtypes of left coronary artery disease

Objective: To study the risk profile associated with surgical revascularization for mixed left main and left main equivalent diseases. Methods and results: Retrospective analysis of medical records of patients who underwent CABG from January 1997 and December 2002 were studied. 210 patients were included of which 30.5% (64) had left main, 49.5% (104) had left main equivalent and 20% (42) had mixed type of stenotic disease. The mixed type left coronary disease was associated with very high post-operative mortality. The factors associated with mortality were degree of left main artery stenosis, cardiopulmonary bypass pump time, no. of packed cell units transfused during surgery, post-operative low cardiac output, re-exploration of chest and no. of days spent as intubated. Low cardiac output, chest re-exploration and no. of days intubated were independently associated with mortality. Conclusions: "Mixed left main and left main equivalent disease" makes a large proportion of left sided CAD. It is a unique subtype associated with very high risk, and it should be treated with extra caution. Characterization of its risk profile should be done with larger studies to improve the outcome.