CORONARY - Bifurcation/Left Main Diseases and Intervention
Early Coronary Artery Bypass Graft (CABG) Failure in High SYNTAX Score: What’s Next?
Yew Fung Kwan1, Tze Ming Chan1, Jian-Chen Lim1, Ramachandran Sathappan1, Benjamin Tao Xiung Lim1, Mohd Ruslan Mustapa1, Gurpreet Pal Singh Jugindar Singh1, Hameeth Shah Abdul Wahid1, Hazleena Mohamed Hasnan1, Nor Hanim Mohd Amin1
Hospital Raja Permaisuri Bainun, Malaysia1,
Patient initials or Identifier Number
Relevant Clinical History and Physical Exam
51 years old Chinese man, smoker with underlying Diabetes Mellitus and 3 vessels disease (3VD) with left main (LM) disease, had CABG x 2 done in March 2020. Left internal mammary artery (LIMA) was grafted to Left Anterior Descending (LAD) artery and saphenous vein graft (SVG) to obtuse marginal (OM) artery. Baseline Echocardiography was normal with ejection fraction (EF) 60 %. 2 months after CABG, he presented with angina for 2 weeks. Vital signs were normal. Physical examination was normal.
Relevant Test Results Prior to Catheterization
12-lead electrocardiography (ECG) showed widespread ST depressions with ST elevation at lead aVR and lead V1. Echocardiography showed moderately impaired LV function with EF 37 % and global hypokinesia. Chest X-ray was normal. Troponin T level was markedly raised. Other blood tests, eg. full blood count, renal profile and liver function test were normal. Hence, he was diagnosed as high risk Non-ST Elevation Myocardial Infarction (NSTEMI).
Relevant Catheterization Findings
IABP was removed after procedure. Patient was discharged well after 2 days. Follow up 6 months after PCI patient remained well and asymptomatic. In conclusion, despite CABG offers more benefits in left main coronary artery disease with high SYNTAX score, complex PCI is an option when patient refuses CABG or ill patient is not stable to be transferred for CABG in a centre without on-site cardiothoracic service. The successful rate will be higher if the procedure is well planned and with intra-coronary imaging guidance.