Procedure Performed by Cardiologist Results in Death

This case involves a fifty-nine-year-old female with a medical history significant for hypertension, diabetes, hyperlipidemia, and obesity. The patient presented to the emergency room with an episode of severe chest pain. She was worked up for an acute coronary syndrome, which included an EKG, blood work for cardiac enzymes, and a chest x-ray. After some deliberations, it was determined that the patient was suffering from multi-vessel coronary artery disease and needed to be sent to the coronary catheterization lab for immediate intervention. During the procedure, the patient became unstable and experienced sudden cardiac death.

Question(s) For Expert Witness

1. What are the indications for this procedure and do the benefits outweigh the possible complications?

Expert Witness Response

The clinical indications for percutaneous coronary intervention include the following: acute ST elevation myocardial infarction STEMI, non ST acute coronary syndrome NSTECS, stable angina, an anginal equivalent (eg, dyspnea, arrhythmia, or dizziness or syncope), or an asymptomatic or mildly symptomatic patient with objective evidence of a moderate-sized to large area of viable myocardium with moderate to severe ischemia on noninvasive testing. Patients that do not meet the indications for PCI intervention should be considered for immediate CABG surgery. Although CABG has been considered the standard of care for patients with unprotected left main CAD (ie, patients without prior CABG or a patent graft to the left anterior descending or left circumflex artery), PCI can improve survival rate and is a reasonable alternative to CABG in selected stable patients who have ≥50% diameter stenosis in the major coronary vessels.