- Patient initials or identifier number:
-Relevant clinical history and physical exam:
85 year old male known hypertensive, type II diabetes mellitus and known Triple vessel coronary artery disease with calcified left main disease. He was admitted with non ST elevation myocardial infarction. He had previously refused CABG following an angiogram for stable angina 2 years prior. A repeat angiogram was performed which revealed complex calcified coronary artery disease with SYNTAX score of 29. Physical examination was unremarkable and he was hemodynamically stable
-Relevant test results prior to catheterization:
His serum creatinine was 0.8mg/dl and troponin was significantly elevated. Electrocardiogram showed Right bundle branch block with ST depressions in I, aVL, V2-V4. Echo showed regional wall abnormality in Left circumflex territory and ejection fraction was 45%.
- Relevant catheterization findings:
Coronary angiogram revealed severely Calcified coronaries. Left main was short and calcified. Left circumflex showed tandem lesions with 80% severity which were calcified and tortuous. Left anterior descending artery was calcified with a 80% ostial lesion and 90% mid lesion. Right coronary artery was calcified, with a distal intermediate lesion.