Case Challenge on Risk Factors for FFR-Guided Deferred Coronary Lesion Intervention | Patient Case Quiz

A 73-year-old Caucasian female presents to the emergency room with sudden onset typical angina of two-hour duration. Her prior medical history includes stage III chronic kidney disease, well controlled hypertension, and diabetes. She is a former smoker. Her medications include metformin, aspirin, and lisinopril. Physical exam was unremarkable. Electrocardiogram (ECG) shows sinus bradycardia with T wave inversions involving leads V3-V6, I and aVL. Echocardiogram reveals left ventricular ejection fraction of 40% and akinesis of entire apex. Laboratory data reveal serum troponin of 1.0 ng/ml (normal <0.04 ng/ml).

She is initiated on medical therapy, including aspirin, clopidogrel, metoprolol, intravenous heparin, lisinopril, and atorvastatin.

Coronary angiogram shows 95% stenosis of the mid left anterior descending artery (LAD), 70% stenosis of distal LAD. Mid LAD lesion is treated with 2.5 X 23 mm everolimus drug eluting stent. Distal LAD lesion is deferred based on fractional flow reserve assessment (FFR value of 0.87).

In this patient, which of the following clinical factors predict a higher risk for the deferred lesion intervention in the future?

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