ISLAMABAD – Left main coronary artery (LMCA) disease can lead to what’s known as a “widowmaker” heart attack, so-called because of the low odds of survival. But this can be avoided if someone is given a stent to open up the narrowed LMCA, or heart bypass surgery, according to Medical Xpress. However, research published in the journal Circulation: Cardiovascular Interventions reveals how doctors may be missing up to 28% of people with LMCA disease because current clinical guidelines on how to interpret test results may need to be updated.
When testing for LMCA disease, doctors typically look for the same blood pressure reduction in both branches of the left main coronary artery. But the new study results overturn this approach—by showing one branch often has lower blood pressure than the other.
This knowledge could in future help doctors better judge whether people have LMCA disease and could benefit from urgent treatment.
Professor Divaka Perera, professor of cardiology at King’s, said, “These findings are so important because they will guide doctors to accurately interpret seemingly conflicting test results when assessing the LMCA. That means doctors can correctly diagnose LMCA disease, and consider a stent or bypass surgery, or carry out further investigations of the LMCA, rather than ignoring a potentially important disease in a major artery of the heart.”
The left main coronary artery is the heart’s largest and most critical artery, supplying most of the heart muscle with blood. If the artery becomes substantially narrowed—as seen in people with LMCA disease—this can result in a major heart attack.
Doctors typically diagnose LMCA disease using a thin wire inserted through the wrist and guided to the heart. They are searching for reduced blood pressure in the two branches leading from the LMCA, which indicate it has been significantly narrowed by a build-up of cholesterol.
But doctors follow guidelines which suggest a blood pressure score below 0.8 is significant and requires immediate treatment.
So, when one branch of the LMCA produces a safer score above 0.8—even if the other does not—doctors following the guidance might rule out LMCA disease.
The researchers say the new findings suggest guidelines should perhaps be updated, so that doctors do not look for the same blood pressure reduction above 0.8 in both branches—the left anterior descending (LAD) artery and the left circumflex artery.
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