Coronary Artery Disease - STEMI Case #10

A 78-year-old female with a history of hypertension, type 2 diabetes and dyslipidemia presents with severe indigestion. She is diaphoretic and dizzy. Her temperature is 98.8, blood pressure 150/90 mm Hg, heart rate 90 beats per minute, respirations 26 per minute. Chest X-ray reveals mild pulmonary edema. Her ECG is below:

LeftMain-Ischemia-WM

Emergent cardiac catheterization is performed. She is found to have a 90% distal left main stenosis but only mild disease in her circumflex, left anterior descending and right coronary artery. Her rhythm then changes to the below:

MonomorphicVTach

Emergent cardioversion is successful, and she is treated with intravenous amiodarone therapy as well as standard medical therapy for an acute coronary syndrome. Which of the following is the next best course of action?

A. Emergency coronary artery bypass grafting

B. Primary percutaneous coronary intervention (PCI) of the left main coronary artery

C. Fibrinolytic therapy

D. Medical management alone

PROCEED TO ANSWER