Clinical presentation and prognosis of left main coronary artery disease in the 1980s

Abstract

Clinical presentation and course were studied in 127 consecutive patients with angiographically proven left main coronary artery disease. Mean age was 62 (37-79) years. Thirteen patients (10%) had no history of chest pain, seven (5%) had atypical chest pain, and the remaining 107 (85%) typical angina pectoris. Eighty-two patients (65%) had unstable angina, 73 had suffered a myocardial infarction (MI) in the past, and 50 (68%) had post MI angina pectoris. The electrocardiogram was analysed in 102/125 patients during an episode of chest pain and also when they were without chest pain. Outside an episode of chest pain the ST segment was normal in 42 patients (32%), the T wave was normal in 50 patients (38%) and both the ST and T were normal in 33 patients (25%). During chest pain all patients had an abnormal ECG, the most frequent pattern being ST segment depression in leads V3, V4 and V5 (with maximal depression in V4), and ST segment elevation in leads V1 and aVR. The average number of leads with ST-T abnormalities was 6.4. A symptom-limited exercise test on a treadmill with 12-lead ECG monitoring was performed in 89 patients. The exercise test was abnormal in 88 patients (99%), most of whom (74 patients) were already in the first or second stage of the Bruce protocol. The most frequently observed abnormality was ST segment depression of 2 mm or more in leads V4, V5, and V6, and ST segment elevation in leads V1 and aVR. The systolic blood pressure during exercise fell or remained at the same level in 38 patients (43%).(ABSTRACT TRUNCATED AT 250 WORDS)

Prevalence of left main coronary artery disease among patients referred to multislice computed tomography coronary examinations

“…In a recent CCA study, significant LMCAD, and nonsignificant LMCAD were found in 4.8% and 3.3% of 17323 patients, respectively [16]. Similar results were obtained for significant LMCAD prevalence in previous studies [17,21]. The relatively lower prevalence of significant LMCAD (2.4%) that was found in our study may be due to the lower risk profile of patients referred to MSCT examinations.…”

Left main coronary stenosis by a mediastinal lymphoma

“…Nearly half of the former had typical chest pain before the acute event [5]. An isolated left main coronary stenosis in the great majority of cases is due to coronary heart disease [1]. External compression by a malignancy may be the most important among the rare causes of left main stenosis, such as inflammatory vessel disease [10], mediastinal irradiation [8], and a muscle bridge.…”

Exercise-Induced ST-Segment Elevation in ECG Lead aVR Is a Useful Indicator of Significant Left Main or Ostial LAD Coronary Artery Stenosis

“…P rior studies have demonstrated that STsegment elevation (STE) in electrocardiographic (ECG) lead aVR in the setting of acute coronary syndromes may indicate the presence of severe stenosis or occlusion of the left main coronary artery (LMCA) or proximal left anterior descending coronary artery (LAD) (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). Data reSee page 187 garding the significance of STE in lead aVR in the setting of exercise treadmill testing (ETT), however, are limited.…”