PCI for Stable Ischemic Heart Disease
A 50-year-old male was evaluated in the office for chest pain. The patient reported substernal chest pressure sensation radiating to left inner arm with associated diaphoresis, brought on by moderate exertion, walking uphill or taking a flight of stairs, relieved by rest. Symptoms started three months ago, and remained stable in severity and fairly predictable. He has history of hypertension, diet controlled diabetes, and dyslipidemia. He is a lifelong non-smoker, and has no family history of premature coronary artery disease. Baseline EKG showed no ST-T abnormalities. Patient was referred for exercise stress testing. On modified Bruce protocol, patient walked for 8 minutes, developed similar chest pain, and 2 mm horizontal ST depression in leads V3-6. Patient was started on aspirin, metoprolol, and atorvastatin. On six weeks follow-up, patient reported minimal improvement in symptoms, and a long acting nitrate was added to the regimen. However, patient remained symptomatic with moderate exertion and was referred for coronary angiography. Coronary angiography revealed normal right coronary artery, left anterior descending in its mid segment had 40% stenosis, and second obtuse marginal branch showed a focal 90% stenosis. Patient underwent successful percutaneous coronary intervention of second OM lesion with a drug eluting stent.
When comparing PCI + OMT (optimal medical therapy) with OMT alone in patients with stable ischemic heart disease, PCI + OMT is associated with: