Clinical Question-8

A 51 years smoker male developed chest discomfort on exertion and presented to the cardiology department.


ECG shows T wave inversion in I , aVL , V4 to V6

Coronary Angiogram

Coronary Angiogram revealed 90% stenosis of proximal segment of LAD


Echocardiogram shows Normal LV Function and Normal Valves and No Regional Wall Motion Abnormality.

Next day patient taken for PCI.

Patient developed chest pain while doing the procedure. This episode was associated with ST Elevation in ECG and profound hypotension.

Angiographically there is persistent slow flow in distal LAD.

Lab report revealed rise in cTn values >5 times of baseline values.

Echocardiogram shows regional wall motion abnormality in LAD territory.

Patient is Shifted to ICU for further management.

What is the complication here?

A. Cardiac Tamponade

B. Coronary artery perforation

C. Myocardial Infarction.

D. Stent Restenosis

What is the classification of this type of Myocardial Infarction?

A. Type – I

B. Type – II

C. Type -IV a

D.Type -V

Criteria for PCI-related MI < 48 h after the index procedure(type 4a MI)

Coronary intervention-related MI is arbitrarily defined by an elevation of cTn values more than five times the 99th percentile URL in patients with normal baseline values.

In patients with elevated pre-procedure cTn in whom the cTn level are stable(<_20%variation) or falling, the post-procedure cTn must rise by>20%.

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