primary pci in multivessels diseases involving LM

interventional cardliology

1. Algorithm for Primary PCI: MVD involving LM Perwaiz M. Meraj MD FACC FSCAI Director, Cardiac Catheterization Lab Director, CHIP/CTO Program Central Regional Director Interventional Cardiology Northwell Health Zucker School of Medicine at Hofstra

2. Faculty Disclosures Relationship: Entity or Entities Consultant: Magenta Medical

3. Step 1 Know what anatomy you are dealing with Step 2 Image, image, image the LM Step 3 Decide if you need support Step 4 Consider asking for help Step 5 KISS

4. Thought? What is the culprit? Can we treat the LAD only? Data: CULPRIT, COMPLETE, PRAMI, etc. Clinical trial data very important, but … The RCA is a CTO – change your plans?

5. Zoghbi J. Open J Cardiol Heart Dis 2018 The National Cardiovascular Data Registry (NCDR)

6. What I do I do not treat every patient the same way How many vessels diseased? Can I treat the culprit without affecting the other lesions? Is the LM an isolated lesion or is it part of the LAD/ LCx disease? Are the hemodynamics conducive to the planned PCI? If I get in trouble, can I get out of it? Do I support the patient?

7. Studies have shown that MCS Placement Pre-PCI is associated with improved outcomes in cardiogenic shock MCS Placement Pre-PCI

8. Conclusions Take each case individually MVD with LM is different from MVD in AMI When the lesions involve the LM then need to take a step back If there is cardiogenic shock, then support before PCI Or if the hemodynamics are poor, then strongly consider support Do as little damage as possible - KISS Stage the non-culprits!

9. Thanks! Northwell Health [email protected] 516-562-3317 Follow on Twitter: @ PerwaizMeraj