ACS in the Setting of Coronary Ectasia: A Challenging Case

A 59-year-old male nonsmoker with medical history of hypertension, strong family history of premature coronary artery disease, and an incidental pancreatic mass was scheduled for biopsy in a week. The patient presented to the emergency department with substernal chest pain. The electrocardiogram was normal. Laboratory evaluation was significant for an elevated troponin I (27 ng/ml). A transthoracic echocardiogram demonstrated normal left ventricular systolic function without wall motion abnormalities. The patient underwent urgent cardiac catheterization for non-ST-segment elevation myocardial infarction (NSTEMI). Findings were a large caliber dominant right coronary artery with mild proximal disease and ectasia with slow flow and proximal left anterior descending (LAD) ectasia with evidence of a ruptured plaque in the mid-segment (just before the takeoff of a bifurcating diagonal branch) with Thrombolysis in Myocardial Infarction 2 flow in the distal LAD. Intravascular ultrasound of the LAD demonstrated a very large caliber vessel with a non-occlusive ruptured plaque in the mid-vessel. Instantaneous wave-free ratio of the mid-LAD culprit lesion was 0.97, consistent with non-significant residual stenosis.

Which of the following is true regarding this patient's condition?

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