CABG vs PCI: Case Presentation #1Dare to Dream

Adnan Kassier, MD

Cardiology Fellow

Spectrum Health – Michigan State University

Grand Rapids, MI

Course Speaker Disclosure Information

Adnan Kassier, MD

Disclosures

None

Question 1

What is the life expectancy for patients with cystic fibrosis?

A. 25

B. 35

C. 45

D. 85

Question 2

SYNTAX score 23- 32; prefer:

A. CABG

B. PCI

C. Doesn’t matter

D. I don’t care

Question 3

Who said:

“Dare to dream, Dare to dream. All our brothers and sisters breathing free. Unafraid, our hopes unswayed”.

A. Abraham Lincoln

B. Martin Luther King Jr

C. Thomas Edison

D. Francis S Collins

Clinical presentation

• 83 years-old-female presents with acute onset chest pain

• Started at work, lasted about 20-30 minutes, and relieved by Nitro

• Physical exam: normal findings except for distant lung sounds.

• PMH: Cystic fibrosis. Patient is employed and work full time.

• Labs: All normal but Troponin I 0.88.

• EKG: NSR with PVCs

Cystic Fibrosis

• Cystic Fibrosis confirmed by sweat chloride as well as genetic testing

• Son died of Cystic fibrosis at age 17

• Patient has chronic cough with small amounts of sputum

• No exacerbations, no hospitalizations. 5 m walk test: 5.17 sec.

• Does not use inhaled medications on a regular basis

• Reported history of mycobacterium avium in sputum cultures in the past, patient refused chronic antibiotic therapy.

Pulmonary Function test

• FVC: 2.05 L 85 %• FEV1: 1.51 L 85 %• FEV1/FVC: 74 • FEV 25-75%: 1.12 L 92 %• TLC: 4.5 L 98 %• VC: 2.11 L 88 %• FRC: 3.17 L 119 %• RV: 2.40 L 119 % • DLCO: 9.1 48 %• DL Adj: 9.6 50 %

Echocardiogram

Normal biventricular function. LVEF 55%. Grade I diastolic dysfunctionModerate hypokinesis of the mid inferior and mid inferolateral walls

Coronary Angiogram

Coronary Angiogram:

LM: Distal left main 30-40% stenosis.

LAD: Diffuse 80-90% stenosis proximal to mid LAD. Focal 70% mid LAD stenosis. Distal LAD good target for graft. Supplies collaterals to marginal branch and distal RCA territoryo D1: 90% ostial stenosis. 90% focal mid stenosis.

LCx: Diffuse 90-95% calcified stenosis in proximal LCx. Diffuse 80% stenosis in proximal OM branch

RCA: Dominant. Tandem lesion 70-80% prox RCA. Severe diffuse calcified disease in mid RCA. Sub-totally occluded marginal branch

Syntax score: 38

STS score: o Mortality 3.1%o Morbidity or mortality: 10.91 %

Dare to Dream

• https://www.youtube.com/watch?v=CbGG2_AjnP0

Thank youAdnan Kassier, MD (Alex)

EKG

Blood Work

• WBC: 8.0 Sodium: 137 Troponin I: 0.88

• RBC: 4.00 Potassium: 4.3 APTT: 18.7

• HgB: 12.9 Chloride: 104 PT: 13.9

• Hct: 36.9 CO2:26

• MCV: 92.4 BUN: 20

• MCH: 32.2 Creatinine: 1.0

• RDW: 13.6 GFR: >60

• Platelet: 301 Calcium: 9.2