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Solaci at EuroPCR. Complex left main PCI Patient presentation

This patient, a 54-year-old male with risk factors including diabetes, hyperlipidemia, and smoking, presents with chest pain at rest and during exertion. With a history of positive exercise test and severe stenosis in the ostial LAD, the treatment recommendation is in equipoise for CABG or PCI. Explore the clinical presentation, angiographic evaluation, and risk assessment data.

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Solaci at EuroPCR. Complex left main PCI Patient presentation

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  1. Solaci at EuroPCR. Complex left main PCIPatient presentation

  2. Complex eft main bifurcation PCIMale, VZM, 54 Risk factors • DM2 (insulin-dependent) • Hyperlipidaemia • Smoker Life style • Active Psychological status • Normal, no cognitive impairment

  3. No Prior clinical history Clinical presentation • One month history of episodes of chest pain at rest and during exertion (15-20 min) • Admitted after an episode of chest pain at rest with no dynamic ECG changes

  4. Laboratory investigations Biomarkers: • TnI: <0.01, CK: 130 (1st ) • TnI: <0.01, CK: 113 (2nd) Creatinine: 0.88 gr/dl Clearance creatinine: 97 ml/min Hb: 16 gr/dl Platelets: 194 000 Total cholesterol: 217 gr/dl HDLc: 33 gr/dl LDLc: 44.4 gr/dl

  5. Non-invasive evaluation • ECG: sinus rythm, 75 bpm, normal repolarisation • Exercise test: ECG positive with ST depression in inferior leads. Clinically

  6. Baseline angiography Medina 0-1-0

  7. Baseline angiography

  8. Risk evaluation Angiographic Syntax score = 12 Syntax score II: • PCI: 18.0 (PCI 4 Year Mortality: 2.5 %) • CABG: 16.2 (CABG 4 Year Mortality: 2.2 %)  Treatment recommendation: equipoise for CABG or PCI STS score = 0.362 EuroSCORE (mortality logistic)= 1.54

  9. Key clinical data & angiographic reference 54 year old male. Diabetic, smoker. Progressive angina with positive exercise test . Severe stenosis ostial LAD

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