When the Second-Best Becomes the Best Choice": High-Risk PCI Saves NSTEMI Patient

A 75-year-old male with NSTEMI and ongoing chest pain has been steered to recovery thanks to a carefully executed high-risk Percutaneous Coronary Intervention (PCI), led by Dr. Gyana Ranjan Nayak, Interventional Cardiologist at SUM Hospital, Bhubaneswar.

The patient presented with ECG showing triple-vessel disease (TVD pattern) and significantly elevated Troponin T (>10).

Coronary angiography revealed:
Diffuse disease in the Right Coronary Artery (RCA) with up to 99% stenosis,
Critical narrowing of the Distal Left Main Coronary Artery (LMCA),
Tight lesions at the ostio-proximal LAD and LCX,
Left Ventricular Ejection Fraction (LVEF) at 35%, indicating compromised cardiac function.

While Coronary Artery Bypass Grafting (CABG) remains the gold standard and is a Class I recommendation for this anatomy, Dr. Nayak noted that in this case, CABG carried a prohibitive surgical risk due to age and reduced EF, making it unfeasible despite being the ideal guideline-based option.

After discussing risks and alternatives, the decision was made to proceed with bifurcation PCI using the mini-crush technique. This strategy allowed revascularization of both LAD and LCX with excellent angiographic results (TIMI 3 flow) and no complications.

"Nothing rivals a LIMA-LAD bypass, but when surgery isn't an option, expertly performed PCI can become the best-and sometimes life-saving-choice," said Dr. Gyana Ranjan Nayak.

About Dr. Gyana Ranjan Nayak
Consultant Interventional Cardiologist at SUM Hospital, Bhubaneswar.
Gold Medalist in MBBS (SCB Medical College, Cuttack) and MD (KGMU, Lucknow); completed DM in Cardiology and Post-Doctoral Fellowship in Interventional Cardiology and Structural Interventions.
Expert in Preventive Cardiology, Heart Failure, Coronary & Structural Interventions, Pediatric Interventions, and advanced diagnostics including TEE and stress echocardiography.
Served as faculty at national and international cardiology symposia, with multiple peer-reviewed publications in coronary intervention and valvular research.
Known as one of the best cardiologists in Bhubaneswar, practicing a patient-centric, empathetic approach to high-quality cardiac care.
Contact and appointment details available via website and WhatsApp: +91 6371307504.

Contact & Additional Resources
Website: https://drgyana.com/
LinkedIn: https://in.linkedin.com/in/dr-gyana-ranjan-nayak-6b298517a
Facebook: https://www.facebook.com/profile.php?id=61566842223603
WhatsApp: +91 6371307504

2nd Floor, MIG-II, Plot No. 203, Kanan Vihar, Patia, Bhubaneswar, Odisha 751024

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