Cor Vasa 2009, 51(6):392-396 | DOI: 10.33678/cor.2009.102

Left main coronary artery stenosis and its clinical picture

Jan Večeřa^1,*, Petr Vojtíšek¹, Ivo Varvařovský², Jan Matějka¹, Jiří Kvasnička¹

¹ Interní klinika - Kardiologické oddělení, Pardubická krajská nemocnice a. s.

² Pracoviště invazivní kardiologie, Kardio-Troll, Pardubice, Česká republika

Aim: The main objective of our study was to evaluate the clinical picture of patients with left main stenosis and their prognosis in our everyday practice.

Material and methods: Ours was a retrospective observational study, with information derived from the medical records of patients having coronary angiography in Pardubice Regional Hospital in 2005. All patients had the left main coronary artery (LMCA) diameter determined using qualitative comparative analysis (QCA). Actual analysis was performed in patients with LMCA stenosis greater than 70% of the artery diameter. Data were obtained from clinical medical records (discharge reports, transfer reports, outpatient findings), ECG curves, and angiographic findings. Incomplete data were complemented via written or phone contacts with the patient or their general practitioners.

Results: The clinical picture of patients with LMCA stenosis does not differ largely from that of the rest of the population with coronary heart disease, where the model patient is an elderly male with hypertension and preserved systolic left ventricular function, who presented with typical severe exertional angina, with unstable angina, or a recent non-ST-segment elevation myocardial infarction. The ECG curve in the presence of myocardial ischemia shows a relatively uniform and typical pattern of deep ST depression in leads V5 and V6, accompanied by elevation in lead aVR. The coronary bed shows predominantly diffuse involvement, with all three coronary arteries involved. The medium-term prognosis of such patients is good if treated surgically.

Conclusion: As a result, it is possible to identify, in clinical practice, patients at high risk, particularly based on the characteristic ECG picture of myocardial ischemia, where the presence of deep ST depressions, consistent with the European Society of Cardiology guidelines, should prompt the indication for emergency coronary angiography.

Keywords: Left main coronary artery stenosis; Clinical picture; ECG

Published: June 1, 2009  Show citation