Impact of Chest Radiation and Separate Coronary Ostia on Left Anterior Descending Artery Dissection in Female Patients

Azhar Shahzad; Fahad Irshaad Siddiqui; Naveed Hussain; Haad Imran; Naheeda Nisar; Rizwan Ali; Uzma Baig

doi:10.70749/ijbr.v3i1.502

Authors

Azhar Shahzad Department of Cardiology, Chaudhary Pervaiz Elahi Institute of Cardiology, Multan, Punjab, Pakistan.
Fahad Irshaad Siddiqui Department of Cardiology, Chaudhary Pervaiz Elahi Institute of Cardiology, Multan, Punjab, Pakistan.
Naveed Hussain Department of Cardiology, Armed Forces Institute of Cardiology (AFIC/ NIHD), Rawalpindi, Punjab, Pakistan.
Haad Imran Department of Internal Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan.
Naheeda Nisar Department of Cardiology, Kutiyana Memon Hospital, Karachi, Sindh, Pakistan.
Rizwan Ali Department of Cardiology, Armed Forces Institute of Cardiology (AFIC/ NIHD), Rawalpindi, Punjab, Pakistan.
Uzma Baig Department of Cardiac Surgery Department, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i1.502

Keywords:

LAD Dissection, Chest Radiation Therapy, Separate Coronary Ostia, Advanced Imaging, Statin Therapy, Dyslipidemia, Coronary Artery Disease (CAD), Chronic Obstructive Pulmonary Disease (COPD)

Abstract

Background: Left anterior descending (LAD) artery dissection is a rare and potentially life-threatening condition, particularly in female patients with a history of chest radiation therapy and congenital coronary anomalies, such as separate ostia of the left coronary arteries. Objective: The main objective of the study is to find the impact of chest radiation and separate coronary ostia on left anterior descending artery dissection in female patients. Methodology: This retrospective observational study was conducted at Chaudhary Pervaiz Elahi Institute of Cardiology, Multan during January 2022 to January 2023. Data were collected from 22 female patients. Results: The mean age of patients was 58.4 ± 8.3 years, with a mean interval of 15.2 ± 6.7 years since chest radiation therapy. Hypertension (54.5%) and diabetes mellitus (40.9%) were common comorbidities. Chest pain was the predominant symptom (90.9%), and LAD dissection was confirmed in all cases through coronary angiography. Separate ostia of the left coronary arteries were identified in 100% of the cohort. Conservative management was applied in 59.1% of cases, while 31.8% underwent percutaneous coronary intervention (PCI), with 85.7% success. In-hospital mortality was 4.5%, and the 12-month event-free survival rate was 81.8%. Conclusions: It is concluded that LAD dissection in this population results from a combination of radiation-induced vascular damage and congenital coronary anomalies. Advanced imaging techniques are critical for diagnosis, and management should be personalized to patient stability and disease severity.

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