1. A 69-year-old man with a prior CABG surgery 8 years ago (LIMA-LAD, SVG-OM2, SVG-RPDA) presents…

1. A 69-year-old man with a prior CABG surgery 8 years ago (LIMA-LAD, SVG-OM2, SVG-RPDA) presents with unstable angina and a troponin T of 0.07 ng per mL. His EKG reveals 2 mm ST-segment depressions in leads I and aVL during chest discomfort. Coronary and graft angiography reveals severe left main trunk disease, occluded mid-LAD, severe proximal circumflex stenosis, and occluded dominant RCA. The grafts to LAD and RCA are patent. The vein graft to obtuse marginal branch has a severe ulcerated stenosis in its midportion with TIMI grade 2 flow. There appears to be an adequate landing zone for a

View complete question »1. A 69-year-old man with a prior CABG surgery 8 years ago (LIMA-LAD, SVG-OM2, SVG-RPDA) presents with unstable angina and a troponin T of 0.07 ng per mL. His EKG reveals 2 mm ST-segment depressions in leads I and aVL during chest discomfort. Coronary and graft angiography reveals severe left main trunk disease, occluded mid-LAD, severe proximal circumflex stenosis, and occluded dominant RCA. The grafts to LAD and RCA are patent. The vein graft to obtuse marginal branch has a severe ulcerated stenosis in its midportion with TIMI grade 2 flow. There appears to be an adequate landing zone for a distal emboli protection device. What is the optimum treatment strategy for this patient? (A) PCI to SVG with distal emboli protection (B) PCI to SVG with adjunctive glycoprotein (GP) IIb/IIIa (C) PCI to left main trunk and proximal circumflex (D) Redo-CABG to OM2 (E) Medical therapy given that LAD and RCA grafts are patent

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