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Review
. 2015 Oct;27(4):272-6.
doi: 10.1016/j.jsha.2015.03.002. Epub 2015 Mar 21.

Treatment strategies in the left main coronary artery disease associated with acute coronary syndromes

Ahmet Karabulut  1 , Mahmut Cakmak  2
Affiliations
Review

Treatment strategies in the left main coronary artery disease associated with acute coronary syndromes

Ahmet Karabulut et al. J Saudi Heart Assoc. 2015 Oct.

Abstract

Significant left main coronary artery (LMCA) stenosis is not rare and reported 3 to 10% of patients undergoing coronary angiography. Unprotected LMCA intervention is a still clinical challenge and surgery is still going to be a traditional management method in many cardiac centers. With a presentation of drug eluting stent (DES), extensive use of IVUS and skilled operators, number of such interventions increased rapidly which lead to change in recommendation in the guidelines regarding LMCA procedures in the stable angina (Class 2a recommendation for ostial and shaft lesion and class 2b recommendation for distal bifurcation lesion). However, there was not clear consensus about the management of unprotected LMCA lesion associated with acute myocardial infarction (MI) with a LMCA culprit lesion itself or distinct culprit lesion of other major coronary arteries. Surgery could be preferred as an obligatory management strategy even in the high risk patients. With this review, we aimed to demonstrate treatment strategies of LMCA disease associated with acute coronary syndrome, particularly acute myocardial infarction (MI). In addition, we presented a short case series with LMCA lesion and ST elevated acute MI in which culprit lesion placed either in the left anterior descending artery or circumflex artery. We reviewed the current medical literature and propose simple algorithm for management.

Keywords: Acute coronary syndrome; CABG, coronary artery bypass graft; CX, circumflex artery; DES, drug-eluting stent; IVUS, intravascular ultrasonography; LAD, left anterior descending artery; LMCA, left main coronary artery; Left main coronary artery; MI, myocardial infarction; PCI, percutaneous coronary interventions; Percutaneous intervention; RCA, right coronary artery; SYNTAX, synergy between percutaneous coronary intervention with TAXUS and cardiac surgery; Surgery; TIMI, thrombolysis in myocardial infarction.

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Figures

Figure 1
Figure 1
A systematic algorithm for LMCA disease in patients with acute coronary syndrome.
See this image and copyright information in PMC

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