So, had a case I've meant to post for a bit now. 66 yo Male who has hx CAD and MI (stent x2 to RCA) approximately 7 years ago, DM2, smoker, who now has abdominal pain. Normal size 66 kg, 67". Pt on plavix, ASA 81 mg, Metoprolol, Norvasc, metformin, MVI.

In November 2011, goes for an EGD and workup--found to have a large abdominal tumor--needs surgery and they want to do a robotic assisted lap gastrojejunostomy with J-tube placement. Seen in preop clinic--order a stress test and is positive for reversible ischemia (lateral and posterior wall abnormalities). Goes for a cath and pt has 40% LAD stenosis, RCA patent with minimal stenosis at stents, and the Cx has some scattered stenosis <50% except at OM1 which is 100% occluded but apparently is known--unable to intervene at time he had his MI 7yrs ago. He's cleared by cardiology and he's to go for procedure early January (there's apparently quite a wait as everyone wants to do the robotic assist (fill in the blank) now a days . . .

Fast forward about a month (mid/late December). Pt starts having bleeding problems (stools). Some confusion in the notes whether it was the pt who decided or the primary or GI MD but ultimately pt stops his ASA and plavix secondary to bleeding. Few days later, pt in ER with chest pain and EKG changes--to cath lab--pt restenosis RCA just proximal to one of previous stents--angioplasy and bought himself a stent in proximal RCA.

Now what are your thoughts/plan/etc?