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What is the optimal stent type and combined antiplatelet/anticoagulation regimen for a patient with a mechanical heart valve presenting with acute coronary syndrome requiring PCI?
What is the optimal stent type and combined antiplatelet/anticoagulation regimen for a patient with a mechanical heart valve presenting with acute coronary syndrome requiring PCI?
This case highlights the clinical dilemma of choosing the optimal stent type and antithrombotic regimen for a patient with a mechanical heart valve requiring PCI for acute coronary syndrome.
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Illustrates unresolved stent and antithrombotic choices in mechanical valve PCI; leaves open optimal strategies for prospective trials.
C ase Presentation:A 76-year-old man was admitted with retrosternal chest pain.The ECG on admission showed inferolateral ST depression, and troponin levels were elevated, confirming the diagnosis of an acute coronary syndrome.The patient had a history of hypertension and aortic valve replacement with a metallic bileaflet valve 7 years before.He was being treated with warfarin and lowdose aspirin and had an international normalized ratio (INR) of 2.5.Coronary angiography revealed a long subocclusive lesion of the proximal right coronary artery.At that point, there was a question about the optimal treatment for this patient regarding the type of stent to be selected and the need for future combined antiplatelet and anticoagulation treatment.
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Sourgounis et al. (2009) studied this question.
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