Prevalence, pathophysiology, and management of the left main coronary artery disease in ST-elevation myocardial infarction: In-depth clinical perspective

Authors

  • Naresh Kumar Khurana Avicenna Medical and Dental college & Hospital Lahore
  • Gulshan Ahmad Punjab Institute of Cardiology, Lahore
  • Hikmat Ali National Institute of cardiovascular diseases, Karachi
  • Suresh Kumar Bolan Medical College Quetta
  • Nighat Saleh Institute of Public Health, Quetta
  • Sheikh Muhmmad Rehman Zia Central Park Teaching Hospital, Lahore

DOI:

https://doi.org/10.55958/jcvd.v20i2.188

Abstract

LMCAD is considered one of the most serious manifestations of CAD because of its association with a high ischemic burden in the myocardium and an increased risk of mortality. STEMI is considered one of the main subsets of ACS and still heads the list of the most life-threatening conditions all over the world. With the coexistence of STEMI and LMCAD, patients have posed peculiar challenges in diagnosis and management. In spite of the advancements made in revascularization techniques such as percutaneous coronary intervention and CABG, the treatment of LMCAD in STEMI patients is still a point of clinical controversy, according to Park et al. (2009). The prevalence of LMCAD in patients presenting with STEMI and its relation to clinical characteristics are also assessed in this paper. This is a cross-sectional analysis carried out for six months, from January to June of 2019, at the National Institute of Cardiovascular Diseases, Karachi. A total of 132 patients, between the age group of 40 to 75 years of age, presenting with an acute STEMI were enrolled. Diagnostic coronary angiography was done to diagnose significant LMCAD, which is ?50% stenosis in the left main coronary artery. Baseline characteristics of the subjects included age, sex, cardiovascular risk factors like hypertension, diabetes mellitus, smoking status, and obesity, and also duration of chest pain. LMCAD prevalence and its association with different characteristics of patients will be statistically analyzed using SPSS version 20. Results: The 132 patients diagnosed with acute STEMI had a mean age of 57.26 ± 8.65 years, with a male preponderance of 79.5%. This study showed that significant LMCAD was found in 6.1% of the patients presenting with STEMI. This result agrees with a global observation of the lesion as being high risk. While comparing the baseline characteristics, the presence of LMCAD did not reflect any remarkable difference among the subjects in terms of gender, age group, diabetes mellitus, hypertension, smoking status, and obesity (p > 0.05). The prevalence of LMCAD was considerably higher graver when compared to the Western populations, focusing on geography-specific risk stratifications and management protocols. This study shows that significant LMCAD is common in patients presenting with acute STEMI, early detection and management; clinical outcomes are improved when based on the anatomical characteristics of the lesion. Revascularization remains a choice between both the PCI and CABG. Further studies will be required to develop evidence-based guidelines in the management of LMCAD, especially in South Asian populations where the burden appears to be higher. Early recognition of LMCAD and comprehensive cardiovascular care may provide a key approach in attempts to reduce morbidity and mortality in patients with STEMI associated with this condition.

Author Biographies

Naresh Kumar Khurana, Avicenna Medical and Dental college & Hospital Lahore

Professor of Cardiology

Hikmat Ali , National Institute of cardiovascular diseases, Karachi

Fellow Interventional Cardiology

Suresh Kumar, Bolan Medical College Quetta

Assistant Professor

Nighat Saleh , Institute of Public Health, Quetta

MPH trainee

Sheikh Muhmmad Rehman Zia , Central Park Teaching Hospital, Lahore

Trainee FCPS cardiology

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Published

2025-01-17

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Section

Articles