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De-escalation of antianginal medications after successful chronic total occlusion percutaneous coronary intervention: Frequency and relationship with health status Long-term Survival following Multivessel Revascularization in Patients with Diabetes (FREEDOM Follow-On Study) ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization: A Report by the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology Endorsed by the American Society of Echocardiography, the Heart Failure Society of America, and the Society of Cardiovascular Computed Tomography The Future of Cardiovascular Computed Tomography Advanced Analytics and Clinical Insights Guiding Principles for Chronic Total Occlusion Percutaneous Coronary Intervention Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation Long-Term Effect of Ultrathin-Strut Versus Thin-Strut Drug-Eluting Stents in Patients With Small Vessel Coronary Artery Disease Undergoing Percutaneous Coronary Intervention: A Subgroup Analysis of the BIOSCIENCE Randomized Trial The performance of non-invasive tests to rule-in and rule-out significant coronary artery stenosis in patients with stable angina: a meta-analysis focused on post-test disease probability Thin Composite-Wire-Strut Zotarolimus-Eluting Stents Versus Ultrathin-Strut Sirolimus-Eluting Stents in BIONYX at 2 Years Appropriate Use Criteria and Health Status Outcomes Following Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the OPEN-CTO Registry
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Clinical Case StudySeptember 18, 2019

JOURNAL：JAMA Cardiol. Article Link

Syncope After Percutaneous Coronary Intervention

Tsushima T, Sahadevan J, Intini A. Keywords: syncope; PCI; clinical case

ABSTRACT

A man in his late 50s with a history of remote coronary artery bypass grafting presented with unstable angina and underwent percutaneous coronary intervention with a drug-eluting stent. He was discharged and prescribed ticagrelor, 90 mg twice daily, in addition to his home regimen of aspirin and metoprolol tartrate. Three months later, he experienced worsening exertional dyspnea and had multiple episodes of syncope. He had no history of syncopal episodes or arrhythmias. His baseline transthoracic echocardiogram results demonstrated normal systolic function and no significant valvular disease. Ambulatory electrocardiogram (ECG) monitoring results showed 31 episodes of high-grade atrioventricular (AV) block (AVB), with ventricular pauses ranging from 3.0 to 13.0 seconds occurring during the day and at night. Among them, 4 episodes were associated with presyncope.

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