CASE REPORT: PATIENT WITH SEVERE THREE-VESSEL CORONARY ARTERY DISEASE (Atena Editora)

Abstract

Introduction: Ischemic heart disease is caused by an imbalance in the blood supply and nutritional needs of cardiac tissue, often due to coronary stenosis of atherosclerotic origin, and is the leading cause of non-traumatic death in Brazil. Methodology: report and discussion of a case of a patient with severe coronary artery disease, of multivessel pattern, hospitalized for Acute Coronary Syndrome (ACS), addressing aspects related to the best management for diagnosis, risk stratification and treatment of the patient. Results and discussions: We reported the case of a patient with typical chest pain who sought care at a municipal emergency room, and an electrocardiogram was performed that showed ST-segment elevation in the wall. Routine medications for ACS were initiated, without improvement. The patient was referred to a tertiary hospital for invasive stratification (cardiac catheterization). The patient rapidly developed signs of cardiogenic shock. Urgent catheterization showed significant three-vessel coronary disease. Surgical revascularization was indicated after clinical stabilization. The patient is currently being followed up in an outpatient setting awaiting surgical scheduling. Conclusion: The case reported allows us to have a broad discussion regarding the various therapeutic options for the treatment of multivessel coronary artery disease: the classic option for myocardial revascularization surgery (the best therapeutic option for these patients, when possible); percutaneous intervention (either by isolated revascularization of the culprit vessel or by complete revascularization) – often chosen in the scenario of multivessel patients who present with ACS; and the option for clinical/drug treatment (especially useful for very elderly patients, with low life expectancy, with multiple comorbidities or with coronary arteries not suitable for receiving grafts or stents). In this complex clinical scenario, the contemporary approach suggests that the choice must be individualized, taking into consideration, the clinical picture, age, comorbidities and coronary angiography (coronary anatomy) of the patient for wise decision-making that allows the patient a greater quality and quantity of life.