Left Main Coronary Disease; Clinical Profile and Angiographic Characteristics

Abstract

Background: To analyze the clinical and angiographic
characteristics of patients with left main coronary
disease(LMCAD).
Methods: In this descriptive study patients with left
main coronary artery disease who underwent angiography
were evaluated. Patients with left main coronary artery
disease ranging from mild plaque to total obstruction were
included. Clinical characteristics, risk factors and
angiographic findings were recorded.
Results: A total of 1422 (10.4%) left main disease cases
were detected in which 953(6.99%) were non-obstructive or
minimal and 468(3.43 %) were obstructive or significant.
Patients with obstructive LMCAD had mean age of
56.32±6.34 years. Male and female were 68.16% and 31.83%,
respectively. Diabetes mellitus (33.97%), hypertension
(62.82%), dyslipidemia (53.84%) and smoking (36.96%)
were main risk factors. Stable angina; FC ІІІ &ІV was seen
in 16.88%, unstable angina in 71.79% and acute MI in
6.83%. On ECG, ST-elevation (>0.05 mV) in lead aVR was
the commonest presentation (90.81%). Exercise ECG were
positive for early angina in 90.81% and diffuse ischemia in
90.81%. Mean ejection fraction ±SD (%) was 48±8.45.
Ostial, midshaft and distal end bifurcating disease was
20.94%,11.11% and 67.94%, respectively. In distal
bifurcating LMCAD, LAD was involved in 56.40% and
circumflex artery in 34.59%. Unprotected LMCAD was
present in 3.1% and protected LMCAD in 0.33%.
Conclusion: Age more than 50, unstable angina,
diffuse ischemic changes on exercise electrocardiograms
and coexistent triple vessels disease were the common
denominators. Distal end of left main stem is the most
common site affected.