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  • Who Will Do the Really Tough Cases?

    The 75-year-old patient with mild anginal symptoms had extensive 3-vessel coronary artery disease, an ejection fraction of 40%, a SYNTAX score of 33, and a Society of Thoracic Surgeons (STS) score of 4%. After a heart-team discussion, the surgeons did not like the vague appearance of the distal target beyond a total occlusion of the circumflex marginal. The interventional cardiologist was asked to take the case. The primary physician asked what the outcome would be with percutaneous coronary intervention (PCI). The interventional cardiologist said, “I think I can open most of the lesions.” The patient asked, “What should I suspect if I continue medical therapy?”

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