Source: Department of Cardiology, Fenyang Hospital, Shanxi Province, Li Yanzhen

On June 4, 2020, a male patient with chest pain for more than 5 hours was admitted to the hospital. The operation was successfully completed and the revascularization was performed. The following is the case information.

Case Profile

● Patient information: male, 59 years old, admitted to the hospital due to chest pain for more than 5 hours

● Past history: hypertension for more than 18 years, blood pressure up to 180/120mmHg, irregular monitoring of blood pressure; denial of diabetes, stroke, digestive system diseases, lung diseases, etc.

● Personal history: He smoked 20 cigarettes a day for 30 years, no history of drinking

● Family history: no family history of coronary heart disease

Hospital examination:

● The ECG showed that the ST-segment elevation was 0.15-0.2mv in leads II, III, AVF, v7-v9

● Three myocardial infarction items: Tn-I 38.29ng/ml, Myoglobin > 500ng/ml, CK-MB 73.79ng/ml diagnosis

Diagnosis

● Coronary heart disease: acute inferior posterior myocardial infarction, cardiac function Class I (Killip)

● Hypertension Stage 3, high risk

Surgical procedure

● Treatment goal: Opening of infarct-related arteries early, fully and continuously

● Emergency coronary angiography was performed: LADm 60% stenosis, D2p 60% stenosis; LCXm 50% stenosis, LCXd 90% stenosis; RCAP-m 70-80% stenosis, PDAo-p70% stenosis The culprit lesion in LCX was observed, and a stent was implanted in the LCX.

● Re-estimated coronary angiography is required to see if RCA intervention is needed.

General treatment

● ECG, blood pressure monitoring and oxygen inhalation therapy;

● Anti-platelet, anticoagulation, stable plaque, improve myocardial ischemia etc.

The postoperative check of ECG showed: sinus rhythm with T-wave in the inferior and anterolateral leads, and pathological Q wave formation.

After regular treatment, the patient's symptoms improved and his vital signs were stable.

Is RCA intervention needed?

To address the need for interventional treatment of RCA intermediate lesions, one week after the operation, a correct decision was made based on caFFR.

As shown in the figure, the preoperative caFFR value in RCA was 0.70. According to the recommendation of the guidelines, PCI in the RCA was performed. Post-PCI caFFR value in RCA was 0.93, which indicates good revascularization.

Postoperative feelings

The patients with moderate stenosis (50-70%) based on coronary angiography, 1/3 of them will be neglected and missed the opportunities for PCI. For severe stenosis( > 70% ) , there will be 20% of patients who were over treated and put more stents. In fact, according to the FFR result, the revascularization can be deferred and standard drug therapy can achieve the desired effect. The establishment of caFFR standards can make up for deficiencies, driving the rapid development of accurate diagnosis and treatment for cardiovascular diseases.