Frequency, Severity, and Management of Left Main Disease in Acute Coronary Syndrome in Sulaimani Cardiac Hospital
DOI:
https://doi.org/10.56056/399Keywords:
Acute myocardial infarction, Coronary artery bypass graft surgery, Left main disease, Percutaneous coronary interventionAbstract
Background and objectives: Approximately 6% of acute coronary syndrome patients undergoing coronary angiography are found to have obstructive left main coronary artery disease. Significant left main stem stenosis, defined as a lesion occupying more than 50% of the vessel diameter. The current study aims to determine the frequency and severity of left main disease among acute coronary syndrome patients and evaluate the management strategies for left main disease.
Methods: This prospective case series study included over 200 acute coronary syndrome patients systematically selected during hospitalization at Sulaimani Cardiac Hospital over one year from June 1, 2023, to June 1, 2024. The patient was diagnosed as myocardial infarction, coronary angiography was done, diseased vessels recorded and SYNTAX score measured. Sampling method based on convenience.
Results: The incidence of left main disease among the 200 patients was 17%. Left main disease was more prevalent in ST elevation myocardial infarction patients compared to non-ST elevation myocardial infarction patients. Out of 34 patients with left main disease, 25 of them were male and 9 patients were female. Patients with triple vessel disease involving the left main had higher Syntax scores (>32). 67% of left main patients were referred for urgent coronary artery bypass graft surgery.
Conclusion: This study highlights the significant burden of left main disease in acute coronary syndrome patients. Coronary artery bypass graft surgery remains the preferred treatment for significant left main stenosis.
Downloads
References
1. Taggart DP, Kaul S, Boden WE, Ferguson TB Jr, Guyton RA, Mack MJ, et al. Revascularization for unprotected left main stem coronary artery stenosis stenting or surgery. J Am Coll Cardiol. 2008; 51:885.
2. Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, et al. Percutaneous coronary intervention versus coronary artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009; 360:961.
3. Fajadet J, Chieffo A. Current management of left main coronary artery disease. Eur Heart J. 2012; 33:36b-50b.
4. Lee PH, Ahn JM, Chang M, Baek S, Yoon SH, Kang SJ, et al. Left Main Coronary Artery Disease. J Am Coll Cardiol. 2016;68(11):1233-1246.
5. El-Menyar AA, Al Suwaidi J, Holmes DR. Left Main Coronary Artery Stenosis: State-of-the-Art. Curr Probl Cardiol. 2007;32(3):103-193.
6. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention: Executive Summary. Catheter Cardiovasc Interv. 2012;79(3):453-495.
7. Ramadan R, Boden WE, Kinlay S. Management of Left Main Coronary Artery Disease. J Am Heart Assoc. 2018;7(7):1-21.
8. Coronary artery surgery study (CASS): a randomized trial of coronary artery bypass surgery. Survival data. Circulation. 1983; 68:939-950.
9. Varnauskas E. Twelve-year follow-up of survival in the randomized European Coronary Surgery Study. N Engl J Med. 1988; 319:332-337.
10. Silber S, Albertsson P, Avilés FF, Paolo G Camici, Antonio Colombo, Christian Hamm et al., for the Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Guidelines for percutaneous coronary interventions. Eur Heart J. 2005; 26:804-847.
11. Seung KB, Park DW, Kim YH, Seung-Whan Lee, Cheol Whan Lee, Myeong-Ki Hong et al. Stents versus coronary-artery bypass grafting for left main coronary artery disease. N Engl J Med. 2008; 358:1781-1792.
12. Chieffo A, Morici N, Maisano F, Erminio Bonizzoni, John Cosgrave, Matteo Montorfano, et al. Percutaneous treatment with drug-eluting stent implantation versus bypass surgery for unprotected left main stenosis: a single-centre experience. Circulation. 2006; 113:2542-2547.
13. Buszman PE, Kiesz SR, Bochenek A, Peszek-Przybyla E, Szkrobka I, Debinski M et al. Acute and late outcomes of unprotected left main stenting in comparison with surgical revascularization. J Am Coll Cardiol. 2008; 51:538-545.
14. Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ et al., for the SYNTAX Investigators. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009; 360:961-972.
15. Naik H, White AJ, Chakravarty T, J Forrester, G Fontana, S Kar et al. A meta-analysis of 3,773 patients treated with percutaneous coronary intervention or surgery for unprotected left main coronary artery stenosis. J Am Coll Cardiol Intv. 2009; 2:739-747.
16. Taggart DP, Kaul S, Boden WE, Ferguson TB Jr, Guyton RA, Mack MJ et al. Revascularization for unprotected left main stem coronary artery stenosis stenting or surgery. J Am Coll Cardiol. 2008; 51:885.
17. Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ et al. Percutaneous coronary intervention versus coronary artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009; 360:961.
18. Fajadet J, Chieffo A. Current management of left main coronary artery disease. Eur Heart J. 2012; 33:36b-50b.
19. Lee PH, Ahn JM, Chang M, Baek S, Yoon SH, Kang SJ et al. Left Main Coronary Artery Disease. J Am Coll Cardiol. 2016;68(11):1233-1246.
20. El-Menyar AA, Al Suwaidi J, Holmes DR. Left Main Coronary Artery Stenosis: State-of-the-Art. Curr Probl Cardiol. 2007;32(3):103-193.
21. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention: Executive Summary. Catheter Cardiovasc Interv. 2012;79(3):453-495.
22. Buszman PE, Kiesz SR, Bochenek A, Peszek-Przybyla E, Szkrobka I, Debinski M, et al. Acute and late outcomes of unprotected left main stenting in comparison with surgical revascularization. J Am Coll Cardiol. 2008; 51:538-545.
23. Seung KB, Park DW, Kim YH, Lee SW, Lee CW, Hong MK, et al. Stents versus coronary-artery bypass grafting for left main coronary artery disease. N Engl J Med. 2008; 358:1781-1792.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Pshtiwan Hussein Qadir, Amar Talib Al-Hamdi, Kawa Wsu Hassan
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The copyright on any article published in AMJ (The Scientific Journal of Kurdistan Higher Council of Medical Specialties )is retained by the author(s) in agreement with the Creative Commons Attribution Non-Commercial ShareAlike License (CC BY-NC-SA 4.0)
