TY  - CHAP
M1  - Book, Section
TI  - Supported Percutaneous Coronary Intervention
A1  - Hawk, Christopher W.
A1  - Alfonso, Carlos E.
A1  - Cohen, Mauricio G.
A2  - Baliga, R. R.
A2  - Lilly, Scott M.
A2  - Abraham, William T.
PY  - 2018
T2  - Color Atlas and Synopsis of Interventional Cardiology
AB  - An  85-year-old  man  with  a  history  of  tobacco  use,  hypertension,  paroxysmal  atrial  fibrillation,  insulin-dependent  diabetes  mellitus,  prior  cerebrovascular  accident,  previous  myocardial  infarction  (MI),  coronary  artery  disease  (CAD),  and  ischemic  cardiomyopathy  presented  with  high-risk  non–ST-segment  elevation  myocardial  infarction  (NSTEMI)  associated  with  heart  failure  symptoms  (New  York  Heart  Association  [NYHA]  class  IV).  Cardiac  exam  revealed  bibasilar  rales,  a  laterally  displaced  point  of  maximal  impulse,  a  regular  rhythm  with  normal  heart  sounds,  and  trace  bilateral  lower  extremity  pitting  edema.  His  electrocardiogram  revealed  normal  sinus  rhythm  and  left  axis  deviation,  along  with  ST  depressions  and  T-wave  inversions  in  the  lateral  leads  suggestive  of  ischemia.  Chest  x-ray  showed  diffuse  pulmonary  edema  and  an  enlarged  cardiac  silhouette.  Laboratory  values  were  notable  for  an  initial  serum  troponin  T  of  0.08  ng/mL  that  peaked  at  0.13  ng/mL,  a  serum  brain  natriuretic  peptide  level  of  1700  pg/mL,  and  serum  creatinine  level  of  0.7  mg/mL.  Echocardiography  showed  severely  reduced  left  ventricular  systolic  function  with  severe  global  hypokinesis,  severe  mitral  regurgitation,  and  a  left  ventricular  ejection  fraction  (EF)  of  20%  to  25%.  Of  note,  6  months  prior  to  this  admission,  his  left  ventricular  systolic  EF  was  45%.  He  was  initially  treated  with  aspirin  and  ticagrelor  and  anticoagulated  with  unfractionated  heparin.  Coronary  angiography  revealed  a  99%  heavily  calcified  bifurcation  lesion  in  the  proximal  left  anterior  descending  (LAD)  coronary  artery  involving  the  origin  of  a  large  first  diagonal  branch,  with  Thrombolysis  in  Myocardial  Infarction  (TIMI)  1  flow.  The  Medina  classification  of  the  lesion  was  1,1,1  (Figure  18-1).  The  left  circumflex  coronary  artery  was  a  diffusely  diseased  vessel  with  a  moderate  lesion  in  the  distal  segment.  The  right  coronary  artery  (RCA)  was  a  dominant  vessel  with  a  severe,  long,  diffuse,  eccentric,  and  heavily  calcified  lesion  in  the  mid  segment  and  a  second  calcified,  focal  lesion  in  the  posterolateral  branch.  There  was  extensive  collateral  circulation  from  the  RCA  to  the  distal  LAD  via  septal  branches  (Figure  18-2).  The  calculated  Society  of  Thoracic  Surgery  predicted  risk  of  mortality  was  11.7%.  The  case  was  discussed  among  the  multidisciplinary  heart  team,  including  cardiothoracic  surgeons  and  interventional  and  noninvasive  cardiologists.  Based  on  his  age  and  comorbidities,  the  patient  was  deemed  to  be  a  poor  candidate  for  coronary  artery  bypass  graft  surgery  (CABG)  and  was  therefore  referred  for  high-risk  percutaneous  coronary  intervention  (HR-PCI).  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accesscardiology.mhmedical.com/content.aspx?aid=1160206950
ER  -