[Clinical evaluation, diagnostic and therapeutic approach to patients with left main coronary artery stenosis].

BACKGROUND

A critical stenosis of the left main coronary artery (LMCA) needs immediate diagnosis and therapy because of poor prognosis due to significant decrease of myocardial perfusion.

AIM

To identify patients with a critical stenosis of LMCA using clinical, biochemical electrocardiographic and echocardiographic data.

METHODS

Consecutive 75 subjects with angiographic result of culprit lesion in LMCA were selected. Coronary artery disease risk factors, resting and exercise ECG changes, regional contractility defects in echocardiography and applied therapy were analysed.

RESULTS

A coexistence of critical LMCA narrowing and sclerotic changes in remaining coronary arteries were present in 93.3% of patients with predilection to the left anterior descending artery (65.3%). An ST segment elevation in aVR lead in resting ECG was correlated with LMCA stenosis in 54.7% of patients. Coronary artery by-pass grafting and resulted in good 1.5-years clinical outcome.

CONCLUSIONS

1. Patients with LMCA stenosis usually have disseminated sclerotic changes in coronary arteries. 2. Evaluation of resting ECG with emphasis on ST elevation in aVR lead may be useful to predict LMCA stenosis. 3. Further studies are required to define factors identifying patients with LMCA disease.