Case 58: Manual of PCI - CABG for STEMI

A diabetic patient presented with posterior MI. He was loaded with ticagrelor 180 mg. Emergency coronary angiography showed 100% occlusion of the first obtuse marginal branch with 3-vessel complex disease. Emergency surgery was declined due to ticagrelor preloading, although CABG could provide better long-term outcomes than PCI.
Balloon angioplasty was performed in the OM1, restoring antegrade TIMI 3 flow. No stents were placed. The patient was started on intravenous eptifibatide and subsequently underwent CABG 4 days later.
In patients with STEMI who are best suited for CABG, balloon angioplasty + intravenous antiplatelet administration could minimize infarct size and "bridge" to surgery, by: (a) reducing the risk of bleeding during surgery by allowing time for the P2Y12 inhibitor effect to wane and (b) avoiding stent implantation.

Видео Case 58: Manual of PCI - CABG for STEMI канала Manos Brilakis