This paper describes the demographic, angiographic and hemodynamic characteristics of forty-six patients with isolated and significant LMCA disease (ILMCAD)in an attempt to determine the etiology of ILMCAD.
We identified 46 patients with ILMCAD from our database over 10 years (Group I) and compared them with 83 consecutive patients that underwent catheterization in our lab (Group II). We also compared ostial vs. distal ILMCAD.
Group I represents 0.1% of catheterization patients. Unstable angina was the commonest presentation followed by non ST elevation myocardial infarction, elective catheterization, syncope and dyspnea on exertion. The comparison of study groups is shown in table 1 and figure 1. Mean left ventricular ejection fraction is similar in both sub-groups (ostial disease-49%, distal disease-50%). About half the patients with ILMCA (n=24/46:52%) disease had the classical “jet streaming” of contrast and was seen more commonly in patients with ostial and mid ILMCA disease. About one-fifths of ILMCA patients (9/46:20%) demonstrated retrograde filling from right coronary artery. Ventricularization was seen in only 4 patients. The majority of patients (23/44:52%) had normal segmental wall motion. An inverse relation was seen between the severity of LMCA stenosis and left ventricular ejection fraction. The left ventricular end diastolic pressure had no correlation with left ventricular ejection fraction or severity of LMCA stenosis.
This is the largest study of patients with ILMCAD. Risk factors for atherosclerosis were commonly seen. Non-atherosclerotic causes of ILMCAD were not seen. ILMCAD is more common in women. Diabetes is more commonly associated with distal lesion. There is a trend suggesting ostial lesion is more common in smokers and women.
This study provides evidence in favour of atherosclerosis being the cause of ILMCAD. It is hoped that aggressive treatment of atherosclerotic risk factors will reduce the prevalence of ILMCAD.
Comparison of Demographic Profile of Patients With ILMCA Disease (Group I) With General Population Seen in Cardiac Catheterization Center (Group II).Risk FactorsGroup I (n=46)Group II (n=83)PvalueAge (in years)65±1365±14Nsd*SexMale22 (48%)57 (69%)0.02Female24 (52%)26 (31%)0.02RaceWhite44 (96%)75 (90%)NsdNon-White2 (4%)8 (10%)NsdHypertension33(72%)59 (71%)NsdHypercholesterolemia30(65%)58 (70%)NsdDiabetes Mellitus20(43%)24 (29%)NsdSmoking12(26%)18 (22%)NsdFamily history18(39%)36(43%)NsdIndication of CatheterizationAngina20 (43%)28 (34%)NsdMyocardial Infarction9 (20%)23 (28%)NsdElective13 (28%)22 (26%)NsdOthers (syncope, dyspnea on exertion, and others)4 (9%)8 (10%)Nsd*
Nsd- No statistically significant difference.
Nitin Mahajan, None.