Left Main Coronary Artery Disease (LMCAD) presents a significant challenge in elderly patients due to the high risk associated with both medical and surgical interventions. In Vietnam, where the population is aging rapidly, the management of LMCAD in elderly patients requires careful consideration of local healthcare practices and resources.This study aims to evaluate the current management strategies for LMCAD in elderly patients in Vietnam, assessing both surgical and non – surgical approaches, and identifying factors that influence treatment outcomes.

A retrospective study was conducted on elderly patients (aged 60 and above) diagnosed with LMCAD at a  geriatric tertiary hospital in Vietnam over a 6-month period. Data were collected on patient demographics, pre-discharge clinical and paraclinical characteristics and treatment-related factors.

A total of 48 elderly patients met the inclusion criteria, with a mean age of 71 ± 7.5 years, and 58.3% were male. The majority presented with multiple comorbidities: hypertension (95.8%), diabetes (47.9%), and chronic kidney disease (31.3%). Medical therapy was the primary treatment approach, with RAAS inhibitors and beta-blockers prescribed to most patients. Primary percutaneous coronary intervention (PCI) was performed in 37.5% of cases, though 33.3% experienced total ischemic times exceeding 48 hours. The mean BCIS-JS score improved from 11.2 pre-intervention to 7 post-intervention, indicating a reduction in disease severity. At discharge, the mean left ventricular ejection fraction (LVEF) was 56.6 ± 14.4%, reflecting moderate left ventricular function. A significant correlation (p < 0.05) was observed between prior stroke history, mitral regurgitation, as well as GRACE score and BCIS-JS post-intervention with treatment decisions. Additionally, elevated LDL-c levels were found to adversely affect treatment outcomes (p < 0.05).

The management of LMCAD in elderly patients, predominantly through medical therapy and PCI, effectively reduces disease severity and improves cardiac function. However, elevated LDL-c levels and delayed intervention are critical factors that negatively impact outcomes, emphasizing the need for timely, personalized treatment strategies.