Abstract| Volume 23, ISSUE 10, SUPPLEMENT , S79, October 2017

Persistent Coronary Intervention Overcame Heart Failure Due to Severely Complicated Acute Coronary Syndrome

      A 57-year-old male with heart failure due to acute coronary syndrome consulted our outpatient and admitted emergently. Three days before the admission, he had been aware of chest pain and dyspnea, and at the admission, the electrocardiogram revealed ST-elevation at the precordial leads of V1–3. Emergent CAG was performed and it showed 3 vessels disease including total occlusion of proximal LAD and obtuse marginal branch, a 90% stenosis of mid LCx and diffuse distal RCA lesions. PCI was carried out to the proximal LAD and obtuse marginal branch, but the guide wire did not pass easily. The operator could not identify the real culprit lesion and stopped the procedure. Then IABP and Swan-Gantz catheter was employed. The HF was managed with furosemide and dobutamine. On the day 4, PCI for LCA was tried again. In this time, obtuse marginal branch was spontaneously re-canalized, and we realized it was the real culprit. We successfully performed PCI for LCx and also tried PCI for the CTO lesion of proximal LAD to stabilize his hemodynamics. Although the procedure was successfully performed, refractory Torsades de Pointes (TdP) occurred. Because medical treatment failed, PCI for RCA distal lesions was performed on the day 18. After the third procedure, the arrhythmia disappeared and the hemodynamics stabilized completely.
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