giovanni esposito md, phd · 2015. 7. 3. · c) surgery d) further assessment . syntax score: 24...
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Giovanni Esposito MD, PhD Dipartimento di Cardiologia, Cardiochirurgia ed Emergenze Cardiovascolari Università degli Studi di Napoli “Federico II”
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M.S.P. 64 y/o Male
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CLINICAL PRESENTATION Risk factors: Hypertension
Hypercholesterolemia Before admission: Chest pain at exertion from 2 months
Admission (05/03/2015): Acute chest pain TnI: 0.3 ng/ml (n.v. < 0.06 ng/ml) CK-MB: 136 ng/ml (n.v. < 6.3 ng/ml) Myoglobin: 96.7 ng/ml (n.v. < 70 ng/ml)
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Echo at admission
Low image quality EF 45% TAPSE 15 mm
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CORONARY ANGIOGRAPHY-RCA
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CORONARY ANGIOGRAPHY-LCA
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What would you do?
A) Treat the culprit lesion only, staging PCI for LAD
B) Treat both vessels in one procedure
C) Surgery
D) Further assessment
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Syntax score: 24
Functional Syntax score
if FFR is ≤ 0.8 in the LAD: 12
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J Am Coll Cardiol 2011;58:1211–8
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FFR- LAD
Contrast-induced Hyperemia
Adenosine-induced Hyperemia
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Coronary artery bypass grafting:
LIMA to LAD
ASV to RCA
Therapeutic strategy
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The angiogram would have got the indication for revascularization of LAD, Cx, and RCA wrong, using FFR as the reference, in 36 (18%), 27 (13.5%), and 17 (8.5%) of 200 cases, respectively.
Indication for revascularization of named vessel based on angiogram, fractional flow reserve (FFR), or both modalities.
LAD Cx
RCA
Circ Cardiovasc Interv. 2014;7:248-255.
The RIPCORD Study
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Circulation. 2014;129:00-00
Registre Français de la FFR – R3F
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30 days clinical Follow-up
The patient is asymptomatic
Low image quality EF 54% TAPSE 18 mm
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Thank you