Basavaraj Devendrappa Baligar, Narendra Shankargouda Hiregoudar, Prakash S. S, Manjunath Nanjappa Cholenahalli, Uday Subhas Bande
BACKGROUND Aim- Coronary artery disease is one of the common cause of death all over the world. There have been only few studies done regarding non-invasive predictors and prevalence of left main (LMD) or triple vessel disease (TVD) in patients with CAD. Uncertainties still exist about their prevalence and predictors in patients with CAD. Our aim was to detect non-invasive predictors, prevalence and clinical profiles of LMD/TVD patients. MATERIALS AND METHODS We collected data of 200 consecutive patients with CAD at our hospital (a tertiary care center). Selective coronary angiography in multiple views was performed by standard technique to define both the extent and severity of disease. Patients with LMD/TVD were included in the study and evaluated for their non-invasive predictors. Patients were divided into two groups-acute coronary syndrome (ACS) group and patients with stable coronary disease group (EA-Effort angina). Stable coronary disease group means TMT positive patients. A predefined proforma was completed in every patient with a detailed clinical history, physical examination, and investigation studies. The clinical history revealed information about age, gender, risk factors, modes of presentation, and duration of symptoms. The details of physical examination including anthropometric data, vital signs and complete systemic evaluation were recorded. The subjects were evaluated for conventional risk factors i.e. smoking, diabetes mellitus, systemic hypertension and family history of premature CAD. RESULTS Diabetes and dyslipidaemia was more common in ACS group compared to EA group and it was statistically significant. AWMI was most common in ACS group. Low ejection fraction and high TIMI score was seen in ACS group and it was statistically significant. Incidence of TVD+LMD was 17%, only TVD 24% and only LMD was 9%, it is comparable with other study. ECG-aVR elevation was seen in 24% patients and it was statistically significant and it is comparable with other study. The most common predictors of TVD/LMD disease were heart failure at clinical presentation (reported in 44% of studies), degree of ST elevation in lead aVR (reported in 24% of cases) and high TIMI score (reported in 88% of cases) were the most powerful predictors, all of them were statistically significant. CONCLUSION We concluded that an ST↑aVR of 0.5 mm or greater predicted LMD/TVD and an independent predictor of prognosis during hospitalization period. Low ejection fraction and high TIMI score are also good noninvasive predictors of LMD /TVD. Prevalence of LMD and TVD in our study was 9% and 24% respectively.
