Coronary artery disease involving left main coronary artery (diagnosis, main treatment approaches)

Abstract

The review analyzes diagnostic and treatment methods and controversies in coronary artery disease involving left coronary artery trunk. Significant occlusion of left main coronary artery is seen in 5-7% of patients with coronary artery disease and is associated with high risk, because this artery gives blood supply for 75-100% of left ventricle myocardium. Involvement of left main coronary artery is considered as an independent predictor for higher prevalence of coronary artery disease and mortality associated with coronary artery disease. Coronary angiography is an appropriate test for diagnosing it. Two types of left main coronary artery involvement are identified - «protected» and «non-protected». In patients on treatment with significant involvement of left main coronary artery, 3-year mortality rate is 50%. Currently a combination of drug treatment and interventional approaches is successfully used to treat coronary heart disease with significant left main coronary artery involvement. The rate of stent angioplasty for such stenosis is currently raising. However, bypass surgery remains to be the «gold standard» treatment in patients with «non-protected» left main coronary artery involvement, and the techniques are constantly improving. Bypass surgery is indicated in patients with left main coronary artery stenosis over 50% and signs of angina pectoris or silent myocardial ischemia. Urgent bypass surgery is preferred in cases of combination of acute coronary syndrome and marked stenosis of left main coronary artery. Presence of unstable angina is an independent predictor for severe concomitant cardiovascular events.