Markedly increased periprocedure mortality of cardiac catheterization in patients with severe narrowing of the left main coronary artery

In early reports, coronary arteriography in patients with left main (LM) coronary artery disease (CAD) had a substantial risk, but recent reports suggest that arteriography in these subjects is now associated with a low mortality. The present study was performed to examine the periprocedure mortality in patients with LMCAD undergoing catheterization, to compare the periprocedure mortality in these patients with that in subjects with less CAD and to identify the variables associated with pericatheterization mortality in this patient cohort. Of 4,009 patients undergoing elective coronary arteriography from 1978 to 1992, 176 had LMCAD. Of the 10 deaths during or within 24 hours of catheterization, 5 occurred in these 176 subjects. This periprocedure mortality of 2.8% in patients with LMCAD was >20 times that of those without LMCAD (0.13%). In comparison with the 171 patients with LMCAD who survived, the 5 who died were older (67 ± 8 vs 58 ± 12 years), and had more severe LMCAD (92 ± 10% vs 72 ± 16%) and a lower cardiac index (1.9 ± 0.4 vs 2.6 ± 0.7 liters/min/m²) (p < 0.05 for all 3 variables). Thus, even in the 1980s and early 1990s, patients with LMCAD have a high pericatheterization mortality, especially those who are older and have severe LMCAD.