Active nonagenarian presenting with worsening angina. Heart Team - surgical turndown, consider high-risk PCI. Single access, Impella supported Rota/Shock/2 stents of LMCA/prox-LAD. Well apposed, fully expanded stents on IVUS. Hemostasis with Perclose/Angioseal.

Late presentation anterior MI 🫢

Is this just the LMCA taking an anomalous course or is the LAD coming off the LCx? Spider 20/20

Lightening 7

Complete or Culprit-Only PCI in Older Patients with Myocardial Infarction: The FIRE Trial NEJM Outstanding work by Simone Biscaglia and colleagues: advancing care for older adults living with ACS 👏🎩 Let's summarize it here: with our 2 friends 🥸😱 👇👇👇

Cr 1.8 Left #radialfirst AL guide. Crossed after much difficulty using a Fielder XT and Turnpike LP. 1.0 mm Sapphire wouldn’t cross. Rota 1.5 mm burr. 4.0 mm Shockwave IVL. 4.0 x 30 Onyx. taken to 4.25 based on IVUS. 60 cc including diagnostic with grafts. Same day D/C.

Anterior STEMI Altered, nauseous, diaphoretic SBP 120-140 POC Lactate high LVEDP > 35 It’s worth remembering that it’s possible to be normotensive and in cardiogenic shock. Increased SVR as a compensatory mechanism for decreased CO.

What’s the diagnosis? “Normal” cMRI

NSTEMI with refractory chest pain. Surgery done out of state and no graph report available. Left radial access. Unable to engage the LMCA despite multiple catheter shapes. Aogram demonstrated something coming off the right aorta. Engaged with an AL3. What do you see? 🕷️

pH 7.09, Lactate 9.3. Acute aortic regurgitation scares me more so than LMCA stenoses.

Resuscitated cardiac arrest status post primary PCI. Written by the patient while still intubated on minimal sedation. 😭

3 Cath Lab activations at 5:30 pm - 2 STEMIs and 1 cardiogenic shock who needed emergent BAV. All three (simultaneously) on tables within 45 mins. Kudos to the Cath Lab staff, many of whom volunteered to stay/come back in. We appreciate you.

NSTEMI, BiPAP, LVEDP 40, EF 25% Shock team discussion following SGC placement -> IABP and 24 hours of optimization with Lasix prior to return to lab. Angulation and calcium both challenges. 1.0 mm balloon to make a hole, 3.0 Shockwave delivered via GL, PCI.

Interesting to reflect on how advances in Intv techniques have changed PCI. Previously, the lesion below would have caused me some angst. Now, just another day in the office … Shockwave->IVUS guided 5.0 mm stent #radialfirst->Same day D/C.

Consider IVUS when placing venous stents. It minimizes the risk of this.

We examined the feasibility of implementing an AI-driven smart alert within our EMR to identify those patients who should appropriately be billed G2211. We ultimately settled on this - 😂😂😂

As PAD and CAD are two sides of the same coin, I think that management of PAD needs to be a formal part of any ICs training. “I can walk again” is as satisfying as “I’m not having any more chest pain.”

It’s absolutely incredible that we now have the tools to drive serum LDL levels to 0. I’m excited to see how this plays out in secondary prevention.