Multiple facets of left main coronary artery disease: A case series of varied spectrum of presentations

Abstract

Left Main Coronary Artery Disease (LMCAD) is a high-risk entity within coronary artery disease, often presenting with variable and complex clinical scenarios that demand urgent recognition and management. This case series describes four interesting and varied presentations of LMCAD: unstable angina in a patient with end-stage renal disease on dialysis; acute coronary syndrome complicated by cardiogenic shock and sepsis; Hemodynamically unstable primary ventricular tachyarrhythmia in an ACS setting; and unstable angina with COPD. All patients underwent successful percutaneous coronary intervention (PCI), including high-risk and emergency interventions, resulting in favourable short- and long-term outcomes. These cases highlight the diagnostic challenges, therapeutic decisions, and clinical recovery achievable with timely and individualized PCI, even in critically ill patients or those with significant comorbidities.