Clinical Profile and Outcome in Patients with Acute Coronary Syndrome (ACS) with Left Main Disease Presenting at Tertiary Care Hospital Karachi, Pakistan

Abstract

Background: Left main coronary artery disease (LMCAD) in acute coronary syndrome (ACS) poses significant concerns due to its vital role in myocardial perfusion. A blockage in this artery can precipitate a severe and potentially fatal heart attack. This study aimed to evaluate the clinical profile and outcomes of ACS patients with LMCAD presenting at a tertiary care hospital in Karachi, Pakistan.

Methodology: This cross-sectional study enrolled consecutive ACS patients with LMCAD, defined as 50% or more stenosis in the left main coronary based on coronary angiography. We assessed the clinical characteristics and in-hospital outcomes of these patients.

Results: Among 236 ACS patients with LMCAD, predominantly male (69.1%) with a mean age of 58.8 ± 9.3 years, most presented with three-vessel disease. Common comorbidities included hypertension (65.3%) and diabetes mellitus (47.9%). Complications, such as contrast-induced nephropathy (13.1%) and major bleeding (2.5%), affected 19.5% of patients, with an in-hospital mortality rate of 4.2%.

Conclusion: The in-hospital mortality rate of 4.2% underscores the grave implications of LMCAD in ACS. The predominance of three-vessel disease highlights its severity and complexity. Complications like contrast-induced nephropathy and major bleeding further accentuate the challenges in managing these cases.