Ischemic heart disease with damage of the left main coronary artery

Аннотация

It is known and proven that the degree of Makhmudova M.M., & Vinokurova E.S. (2025). Ischemic heart disease with damage to the left main coronary artery (LMCA), along damage of the left main coronary artery. The American Journal of Medical with the indicators of the left ventricle (LV) myocardium’s Sciences and Pharmaceutical Research, 7(01), 58–64. https://doi.org/10.37547/tajmspr/Volume07Issue01-08 contractile function, are the main factors determining the survival of patients with coronary artery disease (CAD). Therefore, the effectiveness of the chosen management strategy for such patients determines not only the quality COPYRIGHT of life, i.e relief from angina symptoms, but also long-term © 2025 Original content from this work may be used under the terms of the creative commons attributes 4.0 License. prognosis [1,2]. Keywords: Contractile function, survival of patients. Introduction: It is known and proven that the degree of damage to the left main coronary artery (LMCA), along with the indicators of the left ventricle (LV) myocardium’s contractile function, are the main factors determining the survival of patients with coronary artery disease (CAD). Therefore, the effectiveness of the chosen management strategy for such patients determines not only the quality of life, i.e relief from angina symptoms, but also long-term prognosis [1,2]. More than 100 years have passed since the first description by American physician J. Negis of the case of a death of a 55-year-old patient with large anterior myocardial infarction (MI), complicated by cardiogenic shock, the cause of which, according to the occlusion of the left main coronary artery (LMCA) [2,3]. It was only 50 years ago that the issue of treating such patients became the subject of intense research attention [4]. However, this issue still remains a topic of discussion and debate. One of the most debated questions is the choice of treatment strategy for patients with hemodynamically significant left main coronary artery The American Journal of Medical Sciences and Pharmaceutical Research 58 https://www.theamericanjournals.com/index.php/tajmspr The American Journal of Medical Sciences and Pharmaceutical Research (LMCA) disease. the LAD and Cx. The arterial wall at the blood flow division point is usually unaffected. This patterns of The left main coronary artery (LMCA) is the proximal lesion distribution is found in 80% of patients with segment of the left coronary artery, starting from the stenosis of the trunk [2,11]. left sinus Valsalva and extending to the bifurcation into the left anterior descending (LAD) and circumflex (Cx) Lesions of the LMCA, as assessed by coronary coronary arteries [5]. This type of bifurcation is found angiography (CAG), occur in 4-8% of patients with in two-thirds of cases, while in about one-third of coronary artery disease (CAD) [14–16]. In one of the first patients, the trunk ends in trifurcation, with the third large registries, the CASS (Coronary Artery Surgery branch referred to as the intermediate branch. Cases Study), which included 24,958 patients with of more than three branches are extremely rare. There angiographic evaluations conducted at 14 centers in the are also reports of complete absence of the LMCA United States and Canada between 1974 and 1979, due trunk, where the LAD and Cx arise from separate to the presence of or suspicion of CAD, LMCA lesions orifices. This variant occurs in less than 1% of patients with stenosis of 50% or more were found in 1,484 (5,9%) [6,7]. patients [17]. Isolated LMCA lesions are more the exception than the rule. Most patients with LMCA In the right coronary circulation type, approximately disease have multi-vessel involvement. According to 75% of the blood supplying the myocardium passes various registries and studies, the incidence of isolated through the LMCA, while in the left type, nearly 100% LMCA lesions ranges from 1,5% to 13% [18–20]. The does. Due to this, patients with hemodynamically results of the CASS registry show that isolated LMCA significant LMCA disease have a high risk of mortality lesions were identified in 7% of patients, combined with [2,5]. one additional artery lesion in 13%, two in 27%, and Anatomically, the left main coronary artery (LMCA) is three in 52%. Total occlusion of the LMCA, as assessed divided into the ostium, the middle portion, and the by CAG, is rare, occurring in 0,01-0,7% of cases [21, 22]. distal segment. The average diameter of a healthy When assessing the severity of coronary artery disease LMCA, as measured by angiography, is 4,5 ± 0,5 mm in using the SYNTAX score, LMCA lesions are considered men and 3,9 ± 0,4 mm in women [8]. However, there the most prognostically dangerous, increasing the score have been reports of autopsy findings where the by 5 to 6 points, depending on the type of myocardial diameter of the LMCA in individuals with healthy perfusion [23]. hearts reached 10 mm. The length of the LMCA trunk is highly variable.