Isolated and Significant Left Main Coronary Artery Disease: Demographics, Hemodynamics and Angiographic Features

Abstract

Left main coronary artery disease carries a poor prognosis. The etiology of isolated and significant left main coronary artery (ILMCA) disease is not well understood. Studies so far were limited by small numbers. The authors identified 46 patients with ILMCA disease from their database over 10 years (group I) and compared them with 83 consecutive patients undergoing catheterization (group II). They also compared patients with ostial vs distal ILMCA disease. Group I represented 0.1% of catheterization patients. The demographic profile and atherosclerotic risk factor profile of the 2 groups as well as ostial and distal ILMCA disease were compared. This is the largest study of ILMCA disease. Risk factors for atherosclerosis were commonly seen. Nonatherosclerotic causes of ILMCA disease were not seen. This study suggests coronary atherosclerosis as the predominant cause of ILMCA disease. ILMCA disease is more common in women. Diabetes is more commonly associated with distal ILMCA lesion. There is a trend suggesting that ostial ILMCA lesion is more common in smokers and women.

Aorto-ostial atherosclerotic coronary artery disease—Risk factor profiles, demographic & angiographic features

“…In our study, diabetes was present in 36.8% and smoking 39.6% patients. This statistics are similar to the findings by Mahajan et al [10] and Yildirimturk et al [1]. The prevalence of obesity in the study group was 30.6% of the patients.…”

“…Similar results are seen in studies by Darabian et al [2], Yildirimturk et al [1] and Mahajan et al [10] (Table 6). In our study, diabetes was present in 36.8% and smoking 39.6% patients.…”

“…Significant family history for CAD was present in only 4% of our patients. This does not correlate with the higher prevalence of positive family history that was seen in other studies [1], [2], [10].…”

“…These findings contradict finding in similar studies by Darabian et al [2] and Yildirimturk et al [1] which have observed greater female predominance in ostial CAD. In the study by Mahajan et al, there was a trend suggestive of a higher incidence of ostial lesions among women (63% vs. 31%; P  = .06) [10]. Barner et al reported that 43.5% of their left ostial group and 12% of their left main group were women ( P  <.005) [11].…”

Left main coronary artery stenosis and its clinical picture

“…(14,20) Izolované postižení kmene levé věnčité tepny je málo časté, což bylo již opakovaně popsáno. (13,15) Diagnostickým nálezem na EKG jsou hluboké deprese ST v hrudních svodech V5-V6 hlubší než 0,2 mV, doprovázené elevacemi ST v aVR. Na elevace ST v aVR, jako známku možného postižení LMCA, upozorňují již dřívější práce.…”