Chi Yen Voon 1 , Alan Fong 1 , Tiong Kiam Ong 1 Sarawak Heart Centre, - - PowerPoint PPT Presentation

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Mar 03, 2023 170 likes •414 views

C-150 2-3. Complex PCI Chi Yen Voon 1 , Alan Fong 1 , Tiong Kiam Ong 1 Sarawak Heart Centre, Malaysia 1 Clinical History Mr. DJ, 57 year-old, active smoker. No other medical illness. At 22:40, he presented to non-PCI capable hospital for

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Chi Yen Voon 1, Alan Fong 1, Tiong Kiam Ong 1

2-3. Complex PCI

C-150

Sarawak Heart Centre, Malaysia 1

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Clinical History

Mr. DJ, 57 year-old, active smoker. No other

medical illness.

At 22:40, he presented to non-PCI capable hospital

for chest pain for past 3 hours.

At ED, BP 66/52, bibasal lungs crepitation,

SPO2 92% on high flow mask.

ECG – ST elevation at lead I, AVL, V2-V6 with ST

depression at inferior leads.

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Progression in ED

Intubated and supported with inotropes
Arterial blood gas showed severe metabolic

acidosis

Referred to our centre for primary PCI
Diagnosis – anterior STEMI Khilip 4 with cardiogenic

shock

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PT2MS guide wire into LCX After multiple aspiration

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Re-crossed GW into LAD

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After thrombus aspiration in LAD

POBA to LM-LAD (door to balloon time 75 mins)

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Progress after POBA

After POBA, IABP was inserted
IV Glycoprotein IIb-IIIa inhibitor infusion at

25 mcg/kg was started

Referred to surgeon (on table) for emergency CABG
Echo showed severe global hypokinesia with

EF < 25%

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However, surgery was not done in time
Deteriorated nearly 24 hours after admission
Deteriorating renal function

eGFR 23ml/min/1.73m2

Rescue PCI was decided after discussion with

surgeon

Proceed with PCI at 22:00 (24 hours after

admission)

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BMW GWs into LAD & LCX POBA to LM-LAD with 3.0 x 15 mm NC balloon to 22 atm

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3.5 x 18 mm DES at 14 atm

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Re-crossed GW into LCX

3.75 x 10 mm NC balloon at 12 atm

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Final kissing with 3.75 x 10 mm and 2.0 x 10 mm NC balloon

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Progress of patient

Remained intubated and passed away 34 days after admission due to pneumonia and sepsis

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Conclusion

Although initial POBA aimed to establish good TIMI

flow in LAD and LCX was achieved within 5 hours after the onset of chest pain, but complete revascularization was delayed

This led to delayed myocardial recovery, leading to

prolonged intubation and cardiac rehabilitation, which inevitably invited unnecessary complications such as hospital acquired and ventilator related pneumonia

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Repeated echocardiography after PCI did not show

dramatic improvement in LVEF which implied the importance of early revascularization in patient presented with occluded LM and cardiogenic shock

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Time is muscle is survival

Thank you