Left main coronary artery disease carries a poor prognosis. The etiology of isolated and significant left main coronary artery (ILMCA) disease is not well understood. Studies so far were limited by small numbers. The authors identified 46 patients with ILMCA disease from their database over 10 years (group I) and compared them with 83 consecutive patients undergoing catheterization (group II). They also compared patients with ostial vs distal ILMCA disease. Group I represented 0.1% of catheterization patients. The demographic profile and atherosclerotic risk factor profile of the 2 groups as well as ostial and distal ILMCA disease were compared. This is the largest study of ILMCA disease. Risk factors for atherosclerosis were commonly seen. Nonatherosclerotic causes of ILMCA disease were not seen. This study suggests coronary atherosclerosis as the predominant cause of ILMCA disease. ILMCA disease is more common in women. Diabetes is more commonly associated with distal ILMCA lesion. There is a trend suggesting that ostial ILMCA lesion is more common in smokers and women.
Get full access to this article
View all access options for this article.
References
1.
Herrick J: Clinical features of sudden obstruction of the coronary arteries. JAMA59:2015-2015, 1912.
2.
Black A, Cortina R, Bossi I, et al: Unprotected left main coronary artery stenting: Correlates of midterm survival and impact of patient selection. J Am Coll Cardiol37:832-838, 2001.
3.
Waller BF: Atherosclerotic and nonatherosclerotic factors in acute myocardial infarction. In: Acute Myocardial Infarction, ed. by Pepine C.Philadelphia: FA Davis Co, 1989, p 29-29.
4.
Bulkley BH, Roberts WC: Atherosclerotic narrowing of the left main coronary artery: A necropsy analysis of 152 patients with fatal coronary heart disease and varying degrees of left main narrowing. Circulation53:823-828, 1976.
5.
Judkins MP: Selective coronary arteriography. I. A percutaneous transfemoral technique. Radiology89: 815-824, 1967.
6.
James TN: Anatomy of the Coronary Arteries. Hagerstown, Md: Harper Brothers, 1961, pp 12-150.
7.
Baroldi G, Scomazzoni G: Coronary circulation in the normal and the pathologic heart, Washington, DC: United States Government Printing Office, 1967.
8.
Dodge JT Jr, Brown BG, Bolson EL, et al: Lumen diameter of normal human coronary arteries. Influence of age, sex, anatomic variation, and left ventricular hypertrophy or dilation. Circulation86:232-246, 1992.
9.
Bergelson BA, Tommaso CL: Left main coronary artery disease: Assessment, diagnosis, and therapy. Am Heart J129:350-359, 1995.
Sasaguri S, Honda Y, Kanou T: Isolated coronary ostial stenosis compared with left main trunk disease. Jpn Circ J55:1187-1191, 1991.
12.
Topaz O, Warner M, Lanter P, et al: Isolated significant left main coronary artery stenosis: Angiographic hemodynamic and clinical findings in 16 patients. Am Heart J122:1308-1314, 1991.
Miller GA, Honey M, el-Sayed H: Isolated coronary ostial stenosis. Cathet Cardiovasc Diagn12:30-34, 1986.
15.
Janosi A, Vertes A: Exercise testing and left main coronary artery stenosis. Can patients with left main disease be identified?Chest100:227-229, 1991.
16.
Heggtveit HA: Syphilitic aortitis: A clinicopathologic autopsy study of 100 cases, 1950–1960. Circulation29:346-355, 1964.
17.
Klein RG, Hunder GG, Stanson AW, et al: Large artery involvement in giant cell (temporal) arteritis. Ann Intern Med83:806-812, 1975.
18.
Iga K, Gohma I, Hori K: Regression of the left main trunk lesion by steroid administration in Takayasu's aortitis. Chest99:508-510, 1991.
19.
Yates JD, Kirsh MM, Sodeman TM, et al: Coronary ostial stenosis, a complication of aortic valve replacement. Circulation49:530-534, 1974.
20.
Knutson EL, Smith JC: Coronary ostial stenosis complicating coronary arteriography. Arch Pathol Lab Med100:113-116, 1976.
21.
Tommaso CL, Applefeld MM, Singleton RT: Isolated left main coronary artery stenosis and mediastinal radiotherapy as an etiologic factor. Am J Cardiol61:1119-1120, 1988.
22.
Grollier G, Commeau P, Mercier V, et al: Post-radiotherapeutic left main coronary ostial stenosis: Clinical and histological study. Eur Heart J9:567-570, 1988.
23.
Tenet W, Missri J, Hager D: Radiation-induced stenosis of the left main coronary artery. Cathet Cardiovasc Diagn10:163-166, 1984.
24.
Higgins JC, O'Brien JK, Battle RW, et al: Left main coronary artery compression in patent ductus arteriosus. Am Heart J125:236-239, 1993.
25.
Havranek EP, Dunbar DN: Exertional syncope caused by left main coronary artery spasm. Am Heart J123:792-794, 1992.
26.
Topaz O: Total left main coronary artery occlusion. The acute, the chronic, and the iatrogenic. Chest101:843-846, 1992.
27.
Salem BJ, Terasawa M, Mathur VS, et al: Left main coronary artery ostial stenosis: Clinical markers, angiographic recognition and distinction from left main disease. Cathet Cardiovasc Diagn5:125-134, 1979.
28.
Tommaso CL, Applefeld MM, Scherlist L, et al: Incidence and etiology of isolated left main coronary artery stenosis (abstract). Chest86:284-284, 1984.
29.
Proudfit WL, Shirley EK, Sones FM Jr: Distribution of arterial lesions demonstrated by selective cinecoronary arteriography. Circulation36:54-62, 1967.
30.
Welch CC, Proudfit WL, Sheldon WC: Coronary arteriographic findings in 1,000 women under age 50. Am J Cardiol35:211-215, 1975.
31.
el Fawal MA, Berg GA, Wheatley DJ, et al: Sudden coronary death in Glasgow: The severity and distribution of chronic coronary atherosclerotic stenoses. Br Heart J57:420-426, 1987.
32.
Plotnick GD, Greene HL, Carliner NH, et al: Clinical indicators of left main coronary disease in unstable angina. Ann Intern Med91:149-153, 1979.
Taylor HA, Deumite NJ, Chaitman BR, et al: Asymptomatic left main coronary artery disease in the Coronary Artery Surgery Study (CASS) registry. Circulation79:1171-1179, 1989.
35.
Picano E, Simonetti I, Masini M, et al: Transient myocardial dysfunction during pharmacologic vasodilation as an index of reduced coronary reserve: A coronary hemodynamic and echocardiography study. J Am Coll Cardiol8:84-90, 1986.
36.
Takaro T, Peduzzi P, Detre KM, et al: Survival in subgroups of patients with left main coronary artery disease. Veterans Administration Cooperative Study of Surgery for Coronary Arterial Occlusive Disease. Circulation66:14-22, 1982.
37.
Oberman A, Harrell RR, Russell RO Jr, et al: Surgical versus medical treatment in disease of the left main coronary artery. Lancet2:591-594, 1976.
38.
Takaro T, Hultgren HN, Lipton MJ, et al: The VA cooperative randomized study of surgery for coronary arterial occlusive disease: II subgroup with significant left main lesions. Circulation54:III-107–116, 1976.
39.
Chaitman BR, Fisher LD, Bourassa MG, et al: Effect of coronary bypass surgery on survival patterns in subsets of patients with left main coronary artery disease. Report of the Collaborative Study in Coronary Artery Surgery (CASS). Am J Cardiol48:765-777, 1981.
40.
Yusuf S, Zucker D, Peduzzi P, et al: Effect of coronary artery bypass graft surgery on survival: Overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet344:563-570, 1994.
41.
Eagle KA, Guyton RA, Davidoff R, et al: ACC/AHA guidelines for coronary artery bypass graft surgery: Executive summary and recommendations: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1991 guidelines for coronary artery bypass graft surgery). Circulation100: 1464-1480, 1999.
42.
Park SJ, Park SW, Hong MK, et al: Long-term (threeyear) outcomes after stenting of unprotected left main coronary artery stenosis in patients with normal left ventricular function. Am J Cardiol91:12-16, 2003.
43.
Karam C, Fajadet J, Cassagneau B, et al: Results of stenting of unprotected left main coronary artery stenosis in patients at high surgical risk. Am J Cardiol82:975-978, 1998.
44.
Isner JM, Kishel J, Kent KM, et al: Accuracy of angiographic determination of left main coronary arterial narrowing: Angiographic, histologic correlative analysis in 28 patients. Circulation63:1056-1064, 1981.
45.
Detre KM, Wright E, Murphy ML, et al: Observer agreement in evaluating coronary angiograms. Circulation52:979-986, 1975.
46.
Nishimura RA, Higano ST, Holmes DR Jr: Use of intracoronary ultrasound imaging for assessing left main coronary artery disease. Mayo Clin Proc68: 134-140, 1993.
