A 65-year-old man presents to the chest pain clinic with a 2-month history of exertional chest pain. He has no past medical history of note. On examination his BP is 130/70 mmHg and his heart rate is 65 bpm in sinus rhythm with a 3/6 pansystolic murmur. He has a positive ETT with inferolateral ST segment depression at 5 minutes Bruce protocol. Coronary angiography reveals severe distal left main stem disease, severe mid-LAD disease, severe mid-circumflex disease, and severe distal RCA disease. An echocardiogram shows severe mitral regurgitation with moderate LV systolic dysfunction. CMR confirms viability in all territories.
What should you do next?
A. Refer for multi-vessel angioplastyThis patient has triple vessel disease with objective evidence of ischaemia. This is an indication for CABG. The ESC Guidelines recommend concomitant MVR if the patient has severe MR and LVEF >30% when planned for CABG.