Left main coronary artery stenosis in young patients

Among 1,041 patients less than 45 years old who underwent coronary arteriography from 1972 to 1977, left main coronary stenosis greater than or equal to 50 percent was present in 31 men (3.4 percent) and in 10 women (7.2 percent, P less than 0.05). The degree of stenosis did not correlate with the duration of symptoms, the severity of angina, the presence of a previous myocardial infarction, nor with the number of risk factors. The clinical and angiographic features in young men did not seem to differ from those described in unselected populations; however, in young women, left main coronary stenosis was often an isolated lesion associated with a short duration of symptoms, a high prevalence of hypertension, no previous myocardial infarction, and a normal ventriculogram, suggesting the possibility that a different pathophysiologic mechanism might be involved. Two deaths occurred at angiography (4.9 percent). Thirty patients underwent coronary artery bypass surgery, with one operative death and one late death; good functional results were obtained, and 21 out of 28 survivors (75 percent) were asymptomatic after a mean follow-up of 29 months.