Importance of Identifying Left Main Coronary Artery Narrowing in Subsets of Patients with Coronary Artery Disease

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An important fact that has emerged from numerous studies conducted during the past decade is that all patients with coronary artery disease do not conveniently manifest a homogenous “natural history.” Subgroups of patients can be identified with more ominous prognoses, thereby raising the possibility that such subgroups might benefit from prophylactic surgery. Although many factors predisposing to higher mortality have been implicated, the most powerful seem to be the functional status of the left ventricle and the number of vessels critically narrowed (1–4). Patients with left main coronary artery narrowing have a particularly poor prognosis (5–8), and in several

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