European Journal of Cardiovascular Medicine

Background: NSTE-ACS with significant left main coronary artery (LMCA) disease or its equivalent needs early revascularization in where a significant number of cases CABG may be the treatment of choice. Anticipating LMCA disease or its equivalent may help in proper planning of revascularization. This study was carried out to find out clinical, electrocardiographic and echocardiographic predictors of LMCA disease in high-risk patients with a first episode of NSTE-ACS and also to find out the incidence of LMCA disease among those patients.  Results: In this hospital based observational study 300 patients admitted with 1st episode of NSTE-ACS and classified as very high and high-risk category according to 2015 ESC guideline, were evaluated in respect to clinical, biochemical, ECG and echocardiographic parameters. Later coronary angiography was done. Overall LMCA disease patients were more symptomatic and severely ill but not statistically different from TVD patients. ST elevation in aVR ≥1mm had more specificity but less sensitivity in predicting LMCA disease. ST elevation in both aVR and V1 (ST elevation in aVR ≥ V1) and ST elevation in aVR + ST depression in I, II, V4-6 were other significant ECG predictors of LMCA disease. Incidence of NSVT/VT and high grade of diastolic dysfunction were significantly high among LMCA disease patients. None of the clinical or biochemical parameters could be established as predictor of LMCA disease. Incidence of overweight, central obesity, persistent chest pain, severe shortness of breath, severe heart failure, high total cholesterol, high LDL, low left ventricular ejection fraction and very low left ventricular global longitudinal strain were high among LMCA disease. But there was no statistically significant difference between LMCA disease and TVD with respect to any of these parameters. All of these parameters are significantly better in non LMCA/TVD group and could differentiate LMCA/TVD cases from non LMCA/TVD patients with statistical significance. Conclusion: Though any of these parameters couldn’t predict LMCA disease but these parameters could suggest severe form of coronary artery disease; i.e., either LMCA disease or triple vessel disease which might need urgent CABG.