51-Year-Old Female Patient With Cardiogenic Shock
A 51-year-old woman with a history of chronic kidney disease and hypertension was brought to a community hospital with several days of intermittent chest pain and acute onset dyspnea. The initial electrocardiogram demonstrated anterior Q waves and ST segment elevation (Figure 1). Due to evolving respiratory distress and repeated episodes of non-sustained ventricular tachycardia, the patient required endotracheal intubation. Emergent angiography revealed moderate left main and severe 3-vessel coronary artery disease (CAD) with an occluded left anterior descending (LAD) artery (Figures 2-3). Due to hemodynamic instability, an intra-aortic balloon pump (IABP) was placed and, after an unsuccessful attempt at percutaneous revascularization of the LAD (felt to be chronic or sub-acutely occluded), the patient was referred to a tertiary center for further management including consideration of high risk coronary artery bypass surgery, surgical ventricular assist device implantation, and/or cardiac transplantation evaluation. Two-dimensional echocardiography prior to transfer showed an ejection fraction of 15%. She arrived to the coronary care unit on multiple inotropes and vasopressors with ongoing hemodynamic instability. She was assessed by both surgery and the advanced heart failure/transplant service. From a surgical point of view, she was deemed very high risk for surgical revascularization given her overall clinical status and questionable viability within the anterior wall. She was also deemed not an ideal transplant candidate given her current clinical status, her history of chronic kidney disease, and unclear compliance history.
Which one of the following statements is correct regarding the best management option for this patient?