Can Patients with Left Main Stenosis Safely Wait for Elective Coronary Artery Bypass Grafting?

Background: The purpose of this study was to evaluate the clinical outcomes of patients with left main coronary artery stenosis (LMCA Stenosis) who were placed on a waiting list in a government hospital for coronary artery bypass grafting (CABG). Material and Methods: Between 2013 and 2014, information on 50 patients undergoing isolated coronary artery bypass grafting was gathered both proactively and retrospectively. Fifty patients had either no left main disease or less than 50% left main stenosis (non-LMS group), whereas fifty patients had critical left main stenosis (LMS), which is defined as ≥50% stenosis. Results: Patients with LMS had shorter average times between angiography and surgery. In the LMS group, two patients died during perioperative period. Following non-Q-wave myocardial infarctions, four individuals underwent surgery without experiencing any difficulties. The presence of LMS did not significantly influence operative mortality, incidence of low cardiac output syndrome, or perioperative myocardial infarction. In order to assess how waiting time affected results, LMS patients were separated into: * Early revascularization group: Surgery within 10 days of angiography. * Late revascularization group: Surgery more than 10 days after angiography. The incidence of myocardial infarction, low cardiac output syndrome, and operative mortality were comparable in the two groups. Individuals who underwent early surgery were more likely to: * New York Heart Association (NYHA) Class IV symptoms. * Unstable angina. *Recent preoperative myocardial infarction. Conclusion: Patients with substantial left main stenosis who are carefully chosen can wait for elective coronary artery bypass grafting without a significant increase in perioperative morbidity or mortality. Early surgical intervention should be prioritized for patients with severe symptoms, unstable angina, or a recent preoperative myocardial infarction.

Keywords: Left main Coronary Artery Disease; Coronary artery Bypass Grafting; Waiting Time; Surgical Outcomes; Coronary Revascularisation.