["Needle-to-scalpel"--the benefit of urgent CABG in significant left main coronary artery stenosis].
Left main coronary artery (LMCA) stenosis is a relatively infrequent but important cause of symptomatic coronary artery disease. The diagnosis of left main coronary artery disease is made by coronary angiography. Coronary artery bypass grafting is the first-line therapy, the standard treatment for LMCA stenosis, which improves the likelihood of survival, while percutaneous coronary intervention (PCI) is emerging as a possible alternative to surgery. We present the case of a patient with history and symptoms of stable angina pectoris, especially associated with exercise, variable threshold, since four years, and who describes a worsening of symptoms in the last month; the angina had become more frequent, more prolonged and occurred at a lower threshold. At about 20 hours from getting admitted to our hospital, the patient had severe and prolonged rest angina, associated with important changes on ECG, which led to the indication of emergency coronary angiography. This investigation showed severe left main coronary artery stenosis and significant lesions in other important vessels (three-vessel disease), in a patient with normal left ventricular function. The recurrence and the intensity of prolonged angina of our patient have necessitated urgent myocardial revascularization surgery with quadruple coronary-artery bypass grafting. After surgery, the patient was asymptomatic and he was discharged 8 days after in a good clinical state.


CONCLUSIONS
The advantage of coronary artery bypass grafting performed as urgent surgery for the treatment of our patient with left main coronary artery stenosis and concomitant acute coronary syndrome, shortly after coronary angiography, was obvious, significantly improved the clinical outcome, without postoperative ischemic complications.
Vlădaia
Aurora
A
Institutul de Boli Cardiovasculare Prof. Dr. C.C. Iliescu, Bucureşti. aurora.vladaia@yahoo.com
Ginghină
Carmen
C
Mereuţă
A
A
Moldovan
H
H
D054058:Acute Coronary Syndrome / Q000209:etiology*; D000368:Aged; D017023:Coronary Angiography / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000379:methods; D023921:Coronary Stenosis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D004562:Electrocardiography; D006801:Humans; D008297:Male; D013997:Time Factors; D016896:Treatment Outcome