60-70% occluded RCA (Proximal)

[THIRU]

I am 57 yr old male from India. I suffered ASMI in Jun-2003 and underwent CABG (LIMA to LAD and RIMA to D1). Since then I have been on strict medication (ACE inhibitors, Beta Blockers, Blood thinners, etc.) and diet. Last month after an acute coronary syndrome, I underwent coronary angiogram and was diagnosed with earlier patent grafts and 60-70% occlusion in the proximal RCA. What am I to do now, continue with medication or do I require a PCI? Pl. advise.  THIRU


This discussion is related to Feeling of thumping in the chest after taking antihypertensives and retiring to.

[CCF CCF]

The 60-70% stenosis in the RCA is on the borderline of what most interventionalists would consider needing stenting.  Treatment really depends on if your physician believes this was the culprit for your ACS.  If he does he may want to do a PCI; however if he does not believe it caused your symptoms, he may opt to medically manage, especially if it appears to be closer to less than 70% than more than 70%.

[ed34]

Your RCA is on the borderline for needing intervention, but at the moment it shouldn't be causing any problems at 70%. It certainly doesn't really explain the ACS you experienced. Did they diagnose what caused the event? Has it occurred since?
If I were in your situation I would also be asking myself a very serious question. If your RCA was clear 9 years ago when you had bypass, why is it 70% now? what haven't you done correctly to adjust your lifestyle? I think you need to look at what risks you have. You mention anticoagulation, beta blocker and blood pressure medication but you don't mention any cholesterol meds? Are you not on statins which act as anti-inflamatories for the arteries.