Key result
Medical therapy resolves acute STEMI in anomalous prepulmonic left main coronary artery disease.
Why the study?
A prepulmonic left main coronary artery is usually considered a lower-risk AAOCA subtype, yet it may still be associated with acute ischemic symptoms when significant atherosclerotic coronary artery disease coexists.
Case Report (n=1)
No
Although a prepulmonic anomalous left main coronary artery is typically considered benign, it can present with acute ST-elevation angina when complicated by severe multivessel atherosclerosis and suspected vasospasm, requiring multimodality imaging (invasive angiography and CCTA) to guide management.
Answers are grounded in this paper and cite their sources.
Medical stabilization with nitroglycerin succeeded acutely; leaves open whether medical therapy alone suffices long-term versus revascularization in prepulmonic anomalous LM with multivessel CAD.
Although a prepulmonic left main coronary artery is usually considered a lower-risk AAOCA subtype, it may still be associated with acute ischemic symptoms when significant atherosclerotic coronary artery disease is present. Multimodality imaging is essential for defining the coronary anatomy, and coronary artery bypass grafting may be the preferred strategy when severe multivessel disease coexists.
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Rouzbahani et al. (2026) conducted a case report in Anomalous left main coronary artery (LMCA) arising from the right coronary cusp with a prepulmonic course and significant multivessel coronary artery disease presenting with unstable angina and ST-segment elevation (n=1). Multimodality imaging (invasive coronary angiography and CCTA) and guideline-directed medical therapy (unfractionated heparin, intravenous nitroglycerin, aspirin, atorvastatin, losartan, pantoprazole); inpatient CABG was recommended but declined was evaluated on Resolution of acute chest pain and normalization of ST-segment elevation. Intravenous nitroglycerin and medical therapy resolved acute angina and normalized ST-segment elevations in a 56-year-old woman with a prepulmonic anomalous left main coronary artery and multivessel CAD.
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