Prevalence and non-invasive predictors of left main or three-vessel coronary disease: Evidence from a collaborative international meta-analysis including 22 740 patients

Abstract

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 metaanalysis 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 (95percent 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 20percent (95percent CI 7.2percent to 33.4percent), LMD in 12percent (95percent CI 10.5percent to 13.5percent), and 3VD in 25percent (95percent CI 23.1percent to 27.0percent). 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 36percent (95percent CI 18.5percent to 48.8percent), 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 diseasedthat is, LMD or 3VDdis 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.