A 57-Year-Old Caucasian Male Smoker Presents With Chest Discomfort and Throat Pressure | Patient Case Quiz

A 57-year-old Caucasian male smoker with no significant medical history presents with three days of chest discomfort and throat pressure. The symptoms started while he was biking and initially resolved with rest. However, they recurred later that day and continued intermittently up to the presentation.

Upon arrival, he is free of chest pain. His electrocardiogram (ECG) shows mild ST-segment depressions and T wave changes in the inferior leads and lateral precordial leads (Figure 1). His initial troponin I is elevated at 17.3 ng/mL (normal value <0.05). A two-dimensional transthoracic echocardiogram shows inferior and lateral wall hypokinesis with a left ventricular ejection fraction of 40-45%.

Figure 1

Figure 1

A twelve-lead ECG shows mild ST-segment depressions and T wave changes in inferior and lateral precordial leads.

He is taken to the cardiac catheterization laboratory, and a selective coronary angiogram (Figure 2, Video 1) and left ventriculogram (Video 2) are performed.

Figure 2

Figure 2

Video 1

Cineangiographic imaging shows a right anterior oblique view of the left coronary system with total occlusion of left circumflex coronary artery (solid white arrow).

Video 2

Left ventricular angiogram shows inferolateral hypokinesis in left anterior oblique view.

Based on the clinical presentation and findings on the coronary angiogram, which of the following would be the best treatment strategy?

Show Answer