Case Study

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Case Study 2 Management of a PatientWith ACS
Post-Intervention
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Patient History

• 70-year-old male
• 9 months ago
• Chest discomfort abnormal stress test
• Multiple drug-eluting stents (paclitaxel) placed
  in distal and mid portions of RCA
• Bare metal stent placed in large proximal RCA
• Discharged on clopidogrel 75 mg/d, ASA 325 mg,
  and atorvastatin 10 mg/d

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Initial Presentation (9 Months Later)

• Chest pain persisting for 1 hour
• ST-segment elevations in inferior leads (II, III,
  avF)
• Reports compliant on medications

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(No Transcript)
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Question
What is the most likely cause of this occlusion?

• Clopidogrel resistance
• Aspirin resistance
• In-stent restenosis
• None of the above

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Question
What is the most likely cause of this occlusion?

• Clopidogrel resistance
• Aspirin resistance
• In-stent restenosis
• None of the above

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Action

• Thrombectomy
• Sirolimus-eluting stent placed
• Discharged on antiplatelet therapy

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Question
What do you consider the ideal duration of
antiplatelet therapy for this patient?

• 6 months
• 9 months
• 1 year
• gt 1 year

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Question
What do you consider the ideal duration of
antiplatelet therapy for this patient?

• 6 months
• 9 months
• 1 year
• gt 1 year

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Question
If patient presented 2 years post procedure with
AMI due to late stent thrombosis (no restenosis),
how would you manage?

• Thrombectomy with PTCA
• Thrombectomy and antiplatelet therapy and
  GpIIbIIIa
• Thrombectomy and CABG

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Question
If patient presented 2 years post procedure with
AMI due to late stent thrombosis (no restenosis),
how would you manage?

• Thrombectomy with PTCA
• Thrombectomy with antiplatelet therapy and
  GpIIbIIIa
• Thrombectomy and CABG

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Sponsored by the Annenberg Center for Health
Sciences at Eisenhower
Supported by an independent educational grant
from Daiichi Sankyo, Inc. and Eli Lilly and
Company
This event is not part of the official Scientific
Sessions 2006 as planned by the AHA Committee on
Scientific Sessions Program