Patient handout

Left main coronary artery (LMCA) STEMI-equivalent

PRODUCTION

1. Your condition

This handout is for left main coronary artery (lmca) stemi-equivalent. Your care team identified this based on: avr st↑ ≥1 mm + diffuse st↓ ≥1 mm in ≥6 leads (lmca equivalent / 3-vessel disease).

Other reasons your team may use this plan: severe ischemic chest pain + hypotension/shock + lmca-equivalent ecg → emergent cath + mcs standby; known or newly identified lmca lesion on angio in acute coronary syndrome.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
aspirin	162-325 mg chewed	PO	load + 81 mg daily	ACC/AHA 2025 ACS Class I; same as parent; do NOT hold for CABG (continue peri-CABG per AHA 2025)
ticagrelor	180 mg load → 90 mg BID — HOLD if CABG decided within 5 d; consider cangrelor bridge	PO	BID × 12 mo if PCI	PLATO PMID 19717846; ticagrelor washout 5 d before CABG required to mitigate bleeding (AHA 2025)
cangrelor	30 mcg/kg IV bolus + 4 mcg/kg/min infusion	IV	bridge to oral P2Y12 or off for CABG	Short half-life IV P2Y12 — useful bridge if CABG decision pending or if cardiogenic shock with absent gut absorption
unfractionated heparin	70-100 U/kg IV bolus then per ACT	IV	titrated	AHA 2025 Class I PCI anticoagulant; also required for Impella/ECMO MCS
metoprolol	DEFER until shock resolves and rhythm stable	PO	deferred	BB normally Class I post-MI, but AVOID/defer if SCAI B+ shock or hemodynamic instability; reintroduce only after shock resolution + ≥48h hemodynamic stability — encoded as contraindication_substitute (avoid in acute CS phenotype, restart in chronic management arm)

Plan: LMCA STEMI-equivalent revascularization phenotype — adds to parent cardio.stemi.core.v1 reperfusion regimen with CABG-vs-PCI strategic axis + MCS bias

3. When to call your provider

Contact your care team if any of the following happen:

ICD therapy delivered → urgent EP
EF declining despite the four foundational heart-failure medications → advanced HF eval / transplant
Recurrent angina → cath re-eval (in-stent restenosis or graft failure)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

LMCA-equivalent STEMI + SBP <90 + lactate ≥2 — SCAI C+ cardiogenic shock; high probability given LMCA territory size(life-threatening)
LMCA-equivalent STEMI + biventricular failure (RV + LV); refractory to Impella CP or escalating support(life-threatening)
LMCA bifurcation PCI (left main → LAD/LCx) with side-branch occlusion or stent thrombosis intra-procedure(life-threatening)
LMCA-equivalent STEMI + Heart Team CABG-vs-PCI decision — informed by SYNTAX score, comorbidity, frailty, surgical eligibility, hemodynamic stability

5. Follow-up

Cardiology + cardiac surgery follow-up; echo at 30-90 d for heart pumping strength (LVEF) + ICD eligibility (MADIT-II); cardiac rehab; advanced HF eval if EF <30 not recovering

6. Sources

Guideline: 2025 ACC/AHA ACS Guideline + ESC 2023 ACS + ESC/EACTS 2018 Revascularization + SYNTAX + EXCEL + DK-CRUSH