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Left Main Coronary Artery Disease

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General Information

Description

  • atherosclerosis of the proximal portion of the left coronary artery (left main segment) prior to where it branches into the left anterior descending (LAD) and left circumflex (LCX) arteries. The left main, LAD, and LCX arteries supply blood to most of the left ventricular myocardium1
  • for atherosclerosis of other coronary arteries, see Coronary artery disease (CAD)

Also called

  • left main disease
  • LM disease
  • unprotected left main disease
  • ULM disease
  • UPLM disease

Definitions

  • significant disease defined as left main coronary artery lesion with diameter stenosis > 50% on angiography1
  • for other coronary arteries, stenosis > 70% on angiography considered significant disease (23182125J Am Coll Cardiol 2012 Dec 18;60(24):e44OpenInNewfull-textOpenInNew)
  • protected left main disease refers to patients with patent bypass graft to one of 2 major left circulation branches (left anterior descending or left circumflex coronary artery)2
  • unprotected left main disease (also called ULMD) refers to patients without bypass to the left coronary circulation2
  • distal bifurcation disease refers to lesions involving the origins of the left anterior descending and left circumflex arteries (also called left main equivalent disease)1

References

General references used

  1. Ragosta M. Left main coronary artery disease: importance, diagnosis, assessment, and management. Curr Probl Cardiol. 2015 Mar;40(3):93-126OpenInNew
  2. Li J, Patel SM, Parikh MA, Parikh SA. Unprotected Left Main Disease: Indications and Optimal Strategies for Percutaneous Intervention. Curr Treat Options Cardiovasc Med. 2016 Mar;18(3):19OpenInNew
  3. Rizik DG, Klassen KJ, Burke RF, Hodgson JM, Stone GW. Interventional Management of Unprotected Left Main Coronary Artery Disease: Patient Selection and Technique Optimization. J Interv Cardiol. 2015 Aug;28(4):326-38OpenInNew

Recommendation grading systems used

DynaMed Editorial Process

Special acknowledgements

  • Dale K. Mueller, MD (Section Chief, Department of Surgery, University of Illinois; Cardiovascular and Thoracic Surgeon, HeartCare Midwest SC; Illinois, United States)
  • Dr. Mueller declares no relevant financial conflicts of interest.
  • Peter Oettgen MD, FACC, FAHA, FACP (Editor in Chief; Cardiologist, Beth Israel Deaconess Medical Center; Associate Professor of Medicine, Harvard Medical School, Massachusetts, United States)
  • Dr. Oettgen declares no relevant financial conflicts of interest.
  • DynaMed topics are written and edited through the collaborative efforts of the above individuals. Deputy Editors, Section Editors, and Topic Editors are active in clinical or academic medical practice. Recommendations Editors are actively involved in development and/or evaluation of guidelines.
  • Editorial Team role definitions
    Topic Editors define the scope and focus of each topic by formulating a set of clinical questions and suggesting important guidelines, clinical trials, and other data to be addressed within each topic. Topic Editors also serve as consultants for the DynaMed internal Editorial Team during the writing and editing process, and review the final topic drafts prior to publication.
    Section Editors have similar responsibilities to Topic Editors but have a broader role that includes the review of multiple topics, oversight of Topic Editors, and systematic surveillance of the medical literature.
    Deputy Editors are employees of DynaMed and oversee DynaMed internal publishing groups. Each is responsible for all content published within that group, including supervising topic development at all stages of the writing and editing process, final review of all topics prior to publication, and direction of an internal team.

How to cite

National Library of Medicine, or "Vancouver style" (International Committee of Medical Journal Editors):

  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T909687, Left Main Coronary Artery Disease; [updated 2018 Dec 03, cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T909687. Registration and login required.
  • Related Summaries

  • KeyboardArrowRight

    General Information

    • Description

    • Also called

    • Definitions

  • KeyboardArrowRight

    Epidemiology

    • Incidence/Prevalence

    • Likely risk factors

  • KeyboardArrowRight

    Etiology and Pathogenesis

    • Causes

    • Pathogenesis

  • KeyboardArrowRight

    History and Physical

    • Clinical presentation

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    Diagnosis

    • Making the diagnosis

    • Differential diagnosis

    • Testing overview

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      Imaging studies

      • Invasive coronary angiography

      • Intravascular ultrasound (IVUS)

      • Coronary computed tomography angiography

      • Fractional flow reserve (FFR)

      • Optical coherence tomography (OCT)

    • Cardiac stress testing

    • Electrocardiography (ECG)

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    Management

    • Management overview

    • Risk assessment

    • Medications

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      Surgery and procedures

      • Revascularization indications

      • Efficacy of revascularization

      • Comparative efficacy (CABG vs. PCI)

      • Optimizing CABG outcomes

      • Optimizing PCI outcomes

    • Periprocedural antiplatelet and anticoagulant drugs for PCI

    • Other management

  • KeyboardArrowRight

    Complications and Prognosis

    • Complications

    • Prognosis

  • KeyboardArrowRight

    Prevention and Screening

    • Prevention

    • Screening

  • KeyboardArrowRight

    Guidelines and Resources

    • KeyboardArrowRight

      Guidelines

      • United States guidelines

      • United Kingdom guidelines

      • Canadian guidelines

      • European guidelines

      • Asian guidelines

      • Quality indicators

    • Review articles

    • MEDLINE search

  • Patient Information

  • KeyboardArrowRight

    ICD Codes

    • ICD-10 codes

  • KeyboardArrowRight

    References

    • General references used

    • Recommendation grading systems used

    • DynaMed Editorial Process

    • Special acknowledgements

    • How to cite

Topic Editor
Dale K. Mueller MD
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Affiliations

Section Chief, Department of Surgery, University of Illinois; Illinois, United States; Cardiovascular and Thoracic Surgeon, HeartCare Midwest SC; Illinois, United States

Conflicts of Interest

Dr. Mueller declares no relevant financial conflicts of interest.

Deputy Editor
Peter Oettgen MD
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Affiliations

Editor in Chief, DynaMed; Cardiologist, Beth Israel Deaconess Medical Center; Massachusetts, United States; Associate Professor of Medicine, Harvard Medical School; Massachusetts, United States

Conflicts of Interest

Dr. Oettgen declares no relevant financial conflicts of interest.

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