Solaci at EuroPCR. Complex left main PCI Patient presentation

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

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

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

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

Baseline angiography Medina 0-1-0 Please select the best stop frame image: no AVI’s please, 2 images max

Baseline angiography

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

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