Frequency, Severity, and Management of Left Main Disease in Acute Coronary Syndrome in Sulaimani Cardiac Hospital

Background and objectives: Approximately 6% of acute coronary syndrome patients undergoing coronary angiography are found to have obstructive left main coronary artery disease. Significant left main stem stenosis, defined as a lesion occupying more than 50% of the vessel diameter. The current study aims to determine the frequency and severity of left main disease among acute coronary syndrome patients and evaluate the management strategies for left main disease. Methods: This prospective case series study included over 200 acute coronary syndrome patients systematically selected during hospitalization at Sulaimani Cardiac Hospital over one year from June 1, 2023, to June 1, 2024. The patient was diagnosed as myocardial infarction, coronary angiography was done, diseased vessels recorded and SYNTAX score measured. Sampling method based on convenience. Results: The incidence of left main disease among the 200 patients was 17%. Left main disease was more prevalent in ST elevation myocardial infarction patients compared to non-ST elevation myocardial infarction patients. Out of 34 patients with left main disease, 25 of them were male and 9 patients were female. Patients with triple vessel disease involving the left main had higher Syntax scores (>32). 67% of left main patients were referred for urgent coronary artery bypass graft surgery. Conclusion: This study highlights the significant burden of left main disease in acute coronary syndrome patients. Coronary artery bypass graft surgery remains the preferred treatment for significant left main stenosis.