# 92928 - myocardial infarction



## amym (Jul 5, 2013)

Based on the notes I see 93458-26-59 and 92928-LC, correct?

SUMMARY: 

--  CORONARY CIRCULATION: 
--  Graft to the distal circumflex: The graft was a large sized saphenous 
vein graft from the aorta. There was a 90 % stenosis at the graft ostium. 

--  RECOMMENDATIONS: 
--  S/p DES 3.0 x18 Resolute SVG to LCX graft 
ASA/Plavix 
Staged for LAD lesion due to lesion complexity high risk PCI via LIMA 
Risk factor modification 

PROCEDURES PERFORMED: 

--  Left coronary angiography. 
--  Right coronary angiography. 
--  LIMA graft angiography. 
--  Saphenous vein graft angiography. 
--  LIMA graft angiography. 
--  Coronary Drug Eluding Stent Placement. 
--  PTCA. 

RECOMMENDATIONS: 
S/p DES 3.0 x18 Resolute SVG to LCX graft 
ASA/Plavix 
Staged for LAD lesion due to lesion complexity high risk PCI via LIMA 
Risk factor modification 

INDICATIONS: Angina/MI: myocardial infarction without ST elevation 
(NSTEMI). 

VENTRICLES: There were no left ventricular global or regional wall motion 
abnormalities. 

CORONARY VESSELS: Left main: Normal. LAD: There was a 100 % stenosis in 
the proximal third of the vessel segment. Distal LAD: There was a 95 % 
stenosis. In a second lesion, there was a 70 % stenosis. Proximal 
circumflex: Angiography showed moderate atherosclerosis. Distal 
circumflex: Angiography showed multiple discrete lesions. RCA: There was a 
100 % stenosis. distal vessel filled by bridging collaterals Distal vessel 
angiography showed a medium sized vessel and moderate diffuse disease. 
Graft to the LAD: The graft was a LIMA. Graft angiography showed no 
evidence of disease. Graft to the distal circumflex: The graft was a large 
sized saphenous vein graft from the aorta. There was a 90 % stenosis at 
the graft ostium. Graft to the RCA: The graft was a saphenous vein graft 
from the aorta. There was a 100 % stenosis at the graft ostium. 

PROCEDURE: The risks and alternatives of the procedures and conscious 
sedation were explained to the patient and informed consent was obtained. 
The patient was brought to the cath lab and placed on the table. The 
planned puncture sites were prepped and draped in the usual sterile 
fashion. 

--  Right femoral artery access. The puncture site was infiltrated with 
local anesthetic. The vessel was accessed using the modified Seldinger 
technique, a wire was threaded into the vessel, and a sheath was advanced 
over the wire into the vessel. 

--  Left coronary artery angiography. A catheter was advanced to the aorta 
and positioned in the vessel ostium under fluoroscopic guidance. 
Angiography was performed in multiple projections using hand-injection of 
contrast. 

--  Right coronary artery angiography. A catheter was advanced to the 
aorta and positioned in the vessel ostium under fluoroscopic guidance. 
Angiography was performed in multiple projections using hand-injection of 
contrast. 

--  Left internal mammary graft angiography. A catheter was advanced to 
the aorta and positioned at the aortic anastomosis of the graft under 
fluoroscopic guidance. Angiography was performed in multiple projections 
using hand-injection of contrast. 

--  Saphenous vein graft angiography. A catheter was advanced to the aorta 
and positioned at the aortic anastomosis of the graft under fluoroscopic 
guidance. Angiography was performed in multiple projections using 
hand-injection of contrast. 

--  Left internal mammary graft angiography. A catheter was advanced to 
the aorta and positioned at the aortic anastomosis of the graft under 
fluoroscopic guidance. Angiography was performed in multiple projections 
using hand-injection of contrast. 

LESION INTERVENTION: 

--  Balloon angioplasty was performed, using a Emerge Rx 3.0 x 15mm 
balloon, with 3 inflations and a maximum inflation pressure of 10 atm. 

--  A Resolute Integrity Rx 3.00 x 18mm drug-eluting stent at a maximum 
inflation pressure of 12 atm. 

--  , using a NC Quantum 3.0 x 8 balloon, with 1 inflations and a maximum 
inflation pressure of 15 atm. 

CARDIAC INTERVENTIONS 
--  Coronary Drug Eluding Stent Placement. 

--  PTCA. 

COMPLICATIONS: 
None occurred during the cath lab visit. 

STUDY DIAGRAM 

Angiographic findings 
Native coronary lesions: 
7LAD: Lesion 1: 100 % stenosis. 
7Distal LAD: Lesion 1: 95 % stenosis. Lesion 2: 70 % stenosis. 
7RCA: Lesion 1: 100 % stenosis. 

Coronary graft lesions: 
7Graft to distal circumflex: SVG  7 90 % stenosis at graft ostium. 

7Graft to RCA: SVG  7 100 % stenosis at graft ostium. 

HEMODYNAMIC TABLES 

Pressures:  Baseline 
Pressures:  - HR: 73 
Pressures:  - Rhythm: 
Pressures:  -- Aortic Pressure (S/D/M): 107/57/75 
Pressures:  -- Left Ventricle (s/edp): 104/6/-- 

Outputs:  Baseline 
Outputs:  -- CALCULATIONS: Age in years: 57.17 
Outputs:  -- CALCULATIONS: Body Surface Area: 2.04 
Outputs:  -- CALCULATIONS: Height in cm: 191.00 
Outputs:  -- CALCULATIONS: Sex: Male 
Outputs:  -- CALCULATIONS: Weight in kg: 76.20


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## TWinsor (Jul 7, 2013)

it is hard to tell from the documentation but if the stent was through graft then look at 92937-LC for the intervention.

What about 93459-26-59 for the LHC w/grafts?


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## amym (Jul 8, 2013)

It was PCI of the SVG. Sorry, typo on the cath, it should be 93459.


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## CPCCODERII (Jul 8, 2013)

It is very hard to tell what artery was stented, but if it was a graft I might go with 92937-LC


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