Acute coronary syndromes (ACS) encompass a spectrum of cardiovascular disorders characterized by the sudden onset of myocardial ischemia. They are primarily caused by atherosclerotic plaque rupture or erosion, leading to partial or complete occlusion of the coronary arteries. Among the various coronary arteries affected, left main coronary artery disease (LMCAD) is of particular concern due to its high anatomical significance and potential for adverse outcomes

The left main coronary artery (LMCA) is responsible for supplying a substantial portion of the left ventricular myocardium, including the interventricular septum and the anterior and lateral walls. Any obstruction or compromise in blood flow within this critical artery can have severe consequences, including myocardial infarction, heart failure, or even sudden cardiac death. The management of LMCAD associated with ACS represents a significant clinical challenge, necessitating prompt and optimal treatment strategies

Among the various coronary arteries affected by atherosclerosis, left main coronary artery disease (LMCAD) holds particular clinical significance due to its anatomical location and the vital role it plays in supplying a substantial portion of the left ventricular myocardium. The left main coronary artery (LMCA) typically bifurcates into the left anterior descending artery (LAD) and the left circumflex artery (LCX), which together provide blood supply to the majority of the left ventricle, including the interventricular septum and the anterior and lateral walls

The selection of an appropriate treatment strategy for LMCAD associated with ACS is a complex decision that requires careful consideration of multiple factors, including patient characteristics, coronary anatomy, severity of ischemia, and procedural expertise. The emergence of several clinical trials and observational studies exploring the efficacy and safety of different revascularization strategies has further complicated the decision-making process

Inclusion Criteria:

• Age > 18 years.
• Acute coronary syndromes (ACS).
• Left main coronary artery disease (LMCAD) on CA.

Exclusion Criteria:

• Patients with contraindications to coronary angiography or invasive procedures.
• Prior history of percutaneous coronary intervention (PCI) with left main stenting.
• Known allergy or intolerance to the medications or devices commonly used during PCI procedures.
• Severe comorbidities or conditions that may limit life expectancy or impact the ability to follow the study protocol.
• Pregnancy or lactation.
• Refusal to participate
• Contra indication to antiplatelet.

• Age > 18 years.
• Acute coronary syndromes (ACS).
• Left main coronary artery disease (LMCAD) on CA.