| Autor: |
Yoshimitsu Y; Department of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-22-36, Ohashi Meguro-ku, Tokyo 153-8515, Japan., Awaya T; Department of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-22-36, Ohashi Meguro-ku, Tokyo 153-8515, Japan., Kawagoe N; Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan., Kunimasa T; Department of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-22-36, Ohashi Meguro-ku, Tokyo 153-8515, Japan., Iijima R; Department of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-22-36, Ohashi Meguro-ku, Tokyo 153-8515, Japan., Hara H; Department of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-22-36, Ohashi Meguro-ku, Tokyo 153-8515, Japan. |
| Abstrakt: |
Background: Optimal medical therapy (OMT) is increasingly recognized as a cornerstone in managing chronic coronary syndrome (CCS), offering a non-invasive alternative to percutaneous coronary intervention (PCI). Case Presentation: A 38-year-old male with diabetes, dyslipidemia, and hypertension was treated with early and comprehensive OMT, including statins, ezetimibe, sodium-glucose cotransporter 2 inhibitors (SGLT2i), pioglitazone, and renin-angiotensin system inhibitors. Insulin was introduced during the acute phase to stabilize glycemic control. His HbA1c decreased to 6.3% within 4 months. Results: Over 8 months, the patient experienced a reduction in coronary plaque burden and an improvement in fractional flow reserve (FFR) from 0.75 to 0.90, indicating enhanced coronary blood flow. Plaque volume burden decreased from 85% to 52% in key coronary segments. Conclusions: This case highlights the effectiveness of OMT, including statins, ezetimibe, SGLT2i, and pioglitazone, in achieving outcomes comparable to PCI. FFR-computed tomography follow-up is critical in guiding treatment decisions. Continued OMT is recommended if plaque stabilization is observed. If no improvement is observed, OMT should be intensified, and PCI considered as appropriate. |
