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Case Sharing: A Man in His 40s who Developed Stent Thrombosis during DAPT
Dr. Akira Asanome, Asahikawa-Kosei General Hospital
Case
Male in his 40s
Chief complaint
Sudden chest pain
Current medical history
6 months ago
Hospitalized for congestive heart failure
(Transthoracic echocardiography revealed LVEF 33% [Modified Simpson method])
→Diagnosis of ischemic cardiomyopathy due to 3-vessel disease
→Diagnosis of ischemic cardiomyopathy due to 3-vessel disease
(Angiography and physiology findings: 90% stenosis and FFR 0.78 in the mid RCA, 75% stenosis and FFR 0.72 in the proximal LAD, 75% stenosis and FFR 0.76 in the mid LCX)
→PCI was performed for RCA; 2 DES implanted (#1: 3.5 x 26 mm, #2: 3.0 x 38 mm).
→PCI was performed for RCA; 2 DES implanted (#1: 3.5 x 26 mm, #2: 3.0 x 38 mm).
1 week ago
Performed PCI for LAD; DES implanted (#6-7: 2.75 x 38 mm).
The patient was transferred to our Hospital due to sudden chest pain.
History
2 years ago: fracture of distal end of left radius
Coronary risk factors
Hypertension,
Dyslipidemia,
Insulin-dependent diabetes mellitus,
smoking history
Vital signs
Consciousness clear
Blood pressure 119/81mmHg,
Pulse 94/min (normal),
SpO2 100% (nasal cannula 0.5L/min)
Body temperature 36.5°C
Physical examination
Chest
S1 → S2 → S3 (-) S4 (-)
Apical HSM III/Ⅵ
S1 → S2 → S3 (-) S4 (-)
Apical HSM III/Ⅵ
Pulse normal
PTE (-, -)
PTE (-, -)
Medical therapy
(1) Cardiovascular medicine
Aspirin 100mg/1×,
Prasugrel 3.75mg/1×,
Imidapril 2.5mg/1×,
Eplerenone 25mg/1×,
Allopurinol 100mg/1×
(2) Endocrine medicine
Pitavastatin 4mg/1×,
Ezetimibe 10mg/1×,
metformin 1,000mg/2×,
sitagliptin 50mg/1×,
Insulin aspart (3-0-3-0),
Insulin degludec (0-0-4-0)
Past CAG/PCI
6 months ago
LAO 60#1: 90% (FFR 0.78)
LAO 60#1: DES 3.5 × 26mm, #2: DES 3.0...
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