Complex Coronary Cases

79 years old Male patient that is known with risk factors for coronary artery disease given by systemic hypertension, mild obesity, and severe mixed dyslipidemia with LDL greater than 200 mg, above 400 mg Hypertriglyceridemia and low HDL. Furthermore, he has insulin resistance. Regular treatment: Losartan-Amlodipine 100/5 mg, Rosuvastatin 40 mg, Ciprofibrat 100 mg, Aspirin 100 mg, Metformin 500 mg po tid. He attended medical visit due to small efforts angina on rest, triggered by strong emotions at one month evolution. A cardiac catheterization is decided to be performed prior 96 hours after Clopidogrel loading dose of 300 mg and maintenance of 75 mg po od. Cardiac catheterization revealed Critical Coronary Artery Disease on 3 vessels: 90% lesion in the proximal and distal anterior descending artery with diffuse disease. A 95% lesion in middle and distal segment of circumflex artery and 95% lesion in the right coronary artery proximal segment. This case was classically considered to be of surgical treatment in the past. Today thanks to the results of the Syntax study(www.syntaxtrial.com) which compares both the surgical method and the percutaneous method in patients with multi-vessel arterial disease plus Left Main Trunk disease and which demonstrates that long-term cardiovascular mortality is similar. Complex patients are considered as the aforementioned the possibility of percutaneous myocardial revascularization. Both alternatives were discussed with the patient and his relatives and it was decided to perform a coronary angioplasty with four medicated Stents implant with Everolimus (Xience Prime ®). This procedure was performed in only once administering 450 cc of Iodinated contrast Optiray ®. Once the four medicated Stents were implanted on this diabetic patient, according to study results of TIMI or TRITON 38 and the subsequent analysis, it is decided to switch to Prasugrel loading dose of 30 mg po stat then 10 mg maintenance po od. After 8 months of follow up the patient has remained cardiovascular asymptomatic, with excellent clinical outcome without angina, without dyspnea or difficulty in breathing. No episodes of minor or major bleeding. Renal function remained normal in both immediate and subsequent controls.