Rapid Progression of Left Main Coronary Disease Causing Acute Coronary Syndrome

A 72-year-old man presented with atypical chest pain in December 2009. Thereafter, he underwent coronary angiography that revealed no significant stenosis and no thrombosis of any coronary arteries (Figs 1A, 1B), with normal left ventricular function. He was a nonsmoker, non-diabetic, with mild hypercholesterolemia, and mild hypertension that was well-controlled by medication. In June 2010, he presented with acute coronary syndrome with an electrocardiogram that showed non-ST elevation myocardial infarction. A repeat coronary angiography demonstrated rapid progression of atherosclerotic disease, resulting in critical stenosis of the left main