India live case #32 March 2023

Case & Plan:
Patient Demographics
65 yrs, Male
Present Clinical Presentation
Presented with new onset CCS class II angina. ETT was +for 2mm ST-seg depression in inferior & precordial leads
CAD Risk Factors
Controlled Hyperlipidemia
Controlled Hypertension
Controlled NIDDM
SAQ-7 score:54, Ex-smoker
Clinical Variables
No prior cardiac history with controlled CAD risk factors. Normal EF on echo in the past
Losartan, Metoprolol XL, Atorvastatin, Metformin, Aspirin
Cath: Cath on 2/24/23 revealed 3 V CAD: 100% prox RCA fills retrograde via LAD (J-CTO score 3), 70-90% multiple severely calcified lesions in prox-mid LAD with 80% D3 bifurcation (1,1,1), 60% prox LCx, LVEF 60% and Syntax score 38. After heart team discussion, CABG was declined and recommended high-risk multi-vessel PCI.
Plan: Now planned for IVUS guided complex PCI of calcified LAD-D3 bifurcation and physiological guided LCx intervention.


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