Prevalence of Left main coronary artery disease with diabetes and hypertension in STEMI patients

Aim: To determine the association of left main stem disease with diabetes and hypertension in STEMI patients underwent coronary angiography Methodology: This study was conducted at Department of Cardiology, Sheikh Zayed Hospital, Lahore during January to June 2019 where 220 patients with age ranging from 40-70 years whether male or female, presenting with STEMI, In Exposed Group: Patients presenting with STEMI having diabetes and hypertension and Unexposed Group: Patients of STEMI without diabetes and hypertension. We excluded all cases with recurrent MI or undergoing recurrent PCI (on medical record), valvular heart disease, and cardiogenic shock. Then two groups were formed i.e. exposed group with diabetes and hypertension and unexposed group without diabetes and hypertension. All patients underwent angiography by a senior consultant cardiologist with assistance of researcher. On angiography, presence of LMS disease was ≥50% occlusion (stenosis) in LMS artery. Angiography reports were assessed and LMS disease was noted labeled. Patients with LMS disease was managed as per hospital protocol. Results: In this study risk of LMS was higher among exposed group as compared to un exposed group. i.e. exposed: 19.1% & Unexposed: 5.5%, RR=3.50 The risk of LMS among exposed group was higher for patients in the age group 51-60 years (RR=8.00), for male patients (RR=5.76) risk for LMS was higher as compared to female patients in exposed group, patients with normal BMI (RR:2.20) and patients with shorter duration of STEMI in exposed group had higher risk for LMS (1-4 weeks: RR=7.54). Conclusion: Results of this study showed that hypertensive and diabetic patients presenting with STEMI had higher risk for LMS disease. Keywords: Left main stem, Diabetes, Hypertension, Coronary, Angiography

Download Full-text

Angiographic Severity of Coronary Artery Disease in Diabetic and Non-Diabetic Patients in a Tertiary Care Centre

University Heart Journal ◽

10.3329/uhj.v10i1.24590 ◽

2015 ◽

Vol 10 (1) ◽

pp. 13-17 ◽

Cited By ~ 2

Author(s):

Tanjima Parvin ◽

KMHS Sirajul Haque ◽

Md Abu Siddique ◽

SM Ahsan Habib ◽

Mukhlesur Rahman ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Main Stem ◽

Diabetic Patients ◽

Left Main ◽

Coronary Syndrome ◽

Vessel Disease ◽

Left Main Stem ◽

Severe Coronary Artery ◽

Artery Disease

Objective: Diabetes mellitus, a common metabolic disorder, is often associated with severe coronary artery disease. In this study, we compared the angiographic severity of coronary artery disease in diabetic patients compared with that of non diabetic patients.Methods: This observational study comprised of 102 subjects who had coronary artery disease on coronary angiography in the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2009 to December 2009. The patients were divided into two groups: one group with 24 (23.5%) diabetic patients and another group with 78 (76.5%) non diabetic patients. Demographic, clinical, laboratory and angiographic data were analyzed and compared between two groups.Results: Mean age±SD of the study subjects was 52.8±9.5 years and 94 (92%) of them were male. Diabetic patients were older (mean age±SD; 57.6±9.5 versus 51.3±9.9 years; p 004), and had higher frequency of hypertension (75% versus 50%, p 0.036), chronic stable angina (71% versus 41%, p 0.018), and lower frequency of smoking (42% versus 67%, p 0.034) and acute coronary syndrome (29% versus 59%; p 0.018) in comparison to non diabetic patients. Left main stem disease (21% versus 5%, p 0.031) and three-vessel disease (50% versus 31%, p 0.094) were more prevalent in diabetic patients. Severe coronary artery stenosis was significantly more present in diabetics than non diabetics (Gensini score, 50.9±29.9 versus 32.6±21.9, p 0.001).Conclusion: Diabetic patients are more likely to have severe and extensive coronary artery disease. Left main stem and triple vessel disease are more commonly seen in diabetic patients compared to non diabetic patients.University Heart Journal Vol. 10, No. 1, January 2014; 13-17

Download Full-text

Revascularisation of left main stem disease: a prospective analysis of modern practice and outcomes in a non-surgical centre

Open Heart ◽

10.1136/openhrt-2018-000804 ◽

2018 ◽

Vol 5 (2) ◽

pp. e000804

Author(s):

J J Coughlan ◽

Nial Blake ◽

Napohn Chongprasertpon ◽

Munir Ibrahim ◽

Samer Arnous ◽

...

Keyword(s):

Coronary Artery ◽

Artery Bypass ◽

Coronary Intervention ◽

Main Stem ◽

Left Main ◽

Clinical Registry ◽

Left Main Stem ◽

Modern Drug ◽

Artery Disease ◽

Left Main Stem Disease

PurposeIn this study, we sought to prospectively analyse the management and long term outcomes associated with revascularisation of left main stem disease via percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in our centre.MethodsThis prospective study enrolled all patients with unprotected left main stem disease undergoing revascularisation from January 2013 to June 2014. Baseline characteristics, hospital presentation and hospital stay length were collected. Patients were followed up at 1, 2 and 3 years. Primary outcomes of Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) were defined as death, Q wave myocardial infarction, stroke, repeat revascularisation and readmission within 30 days.Results56 patients with significant left main stem coronary artery disease were identified from the clinical registry. 27 patients underwent PCI (median age 67.7) and 29 CABG (median age 68.6). PCI patients had a higher surgical risk as measured by mean euroSCORE (4.95±5.8 vs 3.11±3.85). At 3 years, total MACCE occurred in 29.6% of the PCI cohort and 27.5% of the CABG cohort. Death occurred in three patients in the PCI group within the first 6 months. Death occurred in one patient in the CABG group over 2 years postprocedure. Two patients in the CABG cohort presented with Transient Ischemic Attacks (TIAs) at 2-year follow-up. At 3 years, revascularisation occurred in three patients in the PCI cohort. There were no revascularisation events in the CABG cohort.ConclusionsPCI with modern drug eluting stents is a reasonable treatment option for unprotected left main stem disease in a non surgical centre.

Download Full-text

Pattern of left main stenosis at a tertiary cardiac center of Nepal

Nepalese Heart Journal ◽

10.3126/njh.v14i1.17193 ◽

2017 ◽

Vol 14 (1) ◽

pp. 29-30

Author(s):

Binay Kumar Rauniyar ◽

Milan Gautam ◽

Ranjit Sharma ◽

Subodh Bir Singh Kansakar ◽

Rajib Rajbhandari ◽

...

Keyword(s):

Coronary Artery ◽

Main Stem ◽

Left Main ◽

Vessel Disease ◽

Left Main Stem ◽

Triple Vessel Disease ◽

Cardiology Department ◽

Artery Disease ◽

Cardiac Center ◽

Left Main Stem Disease

Background and Aims: Left main stem stenosis is defined as a lesion occupying more than 50% of the lumen diameter. Various studies have shown that left main stem stenosis occurs in 4%-6% of all the patients undergoing coronary angiography. We aim to find out the pattern of Left main stem disease in cardiology department of a tertiary cardiac center of Nepal.Methods: This was a retrospective study and was conducted from the properly maintained record of 2 years (August 2011 to July 2013) from cardiaccatheterization labs of Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal.Results: During the study period 3290 coronary angiogram were done. Among them 102 (3.1%) patients had left main stem stenosis of more than 50%. Mean age of the patients with left main stem stenosis was 60.6±10.1yrs. Most of (73.5%) of patients with left main stem stenosis were of age more than 55 years. Most (80.3%) of them were male. Ostial left main stem stenosis was present in 32 (31.3%) patients whereas distal left main stem stenosis was present in 70 (68.6%) patients. In patients with Left main stem stenosis, single vessel disease was present in 12 (11.7%), double vessel disease in 33(32.3%) and triple vessel disease in 49 (48.0%) patients, whereas 8 (7.8%) patients with non-critical coronary artery disease.Conclusion: Left main stem disease is not an uncommon angiographic finding and is often associated with multivessel coronary artery disease. It commonly occurs in distal part of vessel and the patients were older males.Nepalese Heart Journal 2017; 14(1): 29-30

Download Full-text

LEFT MAIN STEM DISEASE ON CORONARY ANGIOGRAPHY IN PATIENTS WITH NON-ST SEGMENT ELEVATION MYOCARDIAL INFARCTION

Pakistan Heart Journal ◽

10.47144/phj.v54i1.2061 ◽

2021 ◽

Vol 54 (1) ◽

pp. 30-33

Author(s):

Kashif Ali Hashmi ◽

Momin Rasheed Khan ◽

Atif Ali Hashmi ◽

Fahar Adnan ◽

Muhammad Irfan

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Coronary Angiography ◽

Main Stem ◽

Left Main ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

Left Main Stem ◽

St Segment ◽

Left Main Stem Disease

Objectives: The purpose of our study was to determine the frequency of left main stem disease on coronary angiography in patients with non-ST segment elevation myocardial infarction (NSTEMI). By studying the exact frequency of the left main stem (LMS) disease in NSTEMI patients in our population, we will be able to better risk stratify and plan further management for this group of patients. Methodology: This cross-sectional study was conducted at the Department of Cardiology, Chaudhry Pervez Elahi Institute of Cardiology (CPEIC), Multan from 14-June-2017 to 13-Dec-2017. Total 248 patients with NSTEMI were included in the study. Coronary angiography was done in all selected patients. Diagnosis of LMS disease was made when stenosis in the LMS artery was more than half of the diameter of the left main coronary artery. Results: There were 80.6% male and 19.4% female patients with a mean age 49.39±7.23 years. In this study, 37.1% patients were found with left main stem disease. Among LMS disease patients, there was 82.6% male and 17.4% female patients. 55.4% of patients were aged 50 years and above. 40.2% were smokers and 33.7% were diabetic. No significant association of LMS was found with the age group (p=0.66), gender (p=0.54), smoking status (p=0.54) and diabetes mellitus (p=0.95). Conclusion: In this study, we found a high frequency of LMS disease in our population. This subset of patients with NSTEMI requires early re-vascularization. This also signifies a need to re-evaluate our screening programs and management protocols related to coronary artery disease.

Download Full-text