In a patient with 75% left main coronary artery stenosis, what is the most important management step?

• A. Daily aspirin to prevent MI
• B. Nitrate therapy for the angina
• C. Aggressive risk factor reduction
• D. Referral for coronary artery revascularization

Answer: (D)

Significant left main coronary artery stenosis is an extremely high-risk situation because this artery supplies a large portion of the heart muscle. When it’s narrowed to a severe degree, the risk of extensive ischemia, myocardial infarction, and death increases unless the blockage is addressed directly. Revascularization—either coronary artery bypass grafting or, in some cases, percutaneous coronary intervention—reduces mortality and improves prognosis by restoring blood flow to a large territory of the heart.

While daily aspirin, nitrate therapy for symptom relief, and aggressive risk factor modification are important parts of overall cardiovascular care, they do not on their own reduce the high mortality risk associated with a major left main lesion as effectively as revascularization. Aspirin helps with platelet prevention, nitrates ease angina symptoms, and risk-factor management lowers long-term risk, but the key step to change survival in this scenario is revascularization.