Giovanni Esposito MD, PhD Dipartimento di Cardiologia, Cardiochirurgia ed Emergenze Cardiovascolari Università degli Studi di Napoli “Federico II”

M.S.P. 64 y/o Male

CLINICAL PRESENTATION Risk factors: Hypertension

Hypercholesterolemia Before admission: Chest pain at exertion from 2 months

Admission (05/03/2015): Acute chest pain TnI: 0.3 ng/ml (n.v. < 0.06 ng/ml) CK-MB: 136 ng/ml (n.v. < 6.3 ng/ml) Myoglobin: 96.7 ng/ml (n.v. < 70 ng/ml)

Echo at admission

Low image quality EF 45% TAPSE 15 mm

CORONARY ANGIOGRAPHY-RCA

CORONARY ANGIOGRAPHY-LCA

What would you do?

A) Treat the culprit lesion only, staging PCI for LAD

B) Treat both vessels in one procedure

C) Surgery

D) Further assessment

Syntax score: 24

Functional Syntax score

if FFR is ≤ 0.8 in the LAD: 12

J Am Coll Cardiol 2011;58:1211–8

FFR- LAD

Contrast-induced Hyperemia

Adenosine-induced Hyperemia

Coronary artery bypass grafting:

LIMA to LAD

ASV to RCA

Therapeutic strategy

The angiogram would have got the indication for revascularization of LAD, Cx, and RCA wrong, using FFR as the reference, in 36 (18%), 27 (13.5%), and 17 (8.5%) of 200 cases, respectively.

Indication for revascularization of named vessel based on angiogram, fractional flow reserve (FFR), or both modalities.

LAD Cx

RCA

Circ Cardiovasc Interv. 2014;7:248-255.

The RIPCORD Study

Circulation. 2014;129:00-00

Registre Français de la FFR – R3F

30 days clinical Follow-up

The patient is asymptomatic

Low image quality EF 54% TAPSE 18 mm

Thank you