244 UA and NSTEMI

Question 0

Type of thrombus seen on angioscopy in patients with UA/NSTEMI (compared to patients with STEMI)

Answer 0

White (platelet-rich) thrombi more common in UA/NSTEMI

Red (fibrin- and cell-rich) thrombi more common in STEMI

Question 1

Findings at angiography of patients with UA/NSTEMI and corresponding percentages

Answer 1

40% single-vessel disease
30% two-vessel disease
15% three-vessel CAD
10% no apparent critical stenosis
5% left main coronary artery stenosis

Question 2

% risks of the ff. in patients with UA/NSTEMI:

1. Early (30-day) death
2. Recurrent infarction
3. Recurrent ACS

Answer 2

1. Early (30-day) death: 1-10%
2. Recurrent infarction: 3-5%
3. Recurrent ACS: 5-15%

Question 3

Components of the TIMI Risk Score for patients with UA/NSTEMI (7)

Answer 3

1. 3 or more CAD risk factors
2. Age 65 and above
3. Recurrent angina (2 or more in 24h)
4. Aspirin use in the past 7 days
5. Prior stenosis >50%
6. ST deviation (0.5 mm)
7. Elevated cardiac markers

Question 4

Trial which demonstrated 40% reduction in recurrent cardiac events conferred by an early invasive strategy in patients with a positive troponin level

Answer 4

TACTICS-TIMI 18 Trial

Question 5

Trial which compared high-dose vs. low-dose aspirin for 30 days for patients with UA/NSTEMI. No difference seen in the risk of major bleeding or in efficacy.

Answer 5

OASIS-7

Question 6

Results of the CURE Trial

Answer 6

Clopidogrel in combination with aspirin conferred a 20% relative reduction in CV death, MI, or stroke, compared with aspirin alone in both low- and high-risk patients; moderate (1%) increase in major bleeding

Question 7

A variant of this cytochrome P450 system gene leads to reduced conversion of clopidogrel to its active metabolite, causing lower platelet inhibition and higher risk of CV events

Answer 7

2C19

Question 8

Trial which showed that relative to clopidogrel, prasugrel reduced the risk of CV death, MI, or stroke significantly by 19%, with an increase in major bleeding

Answer 8

TRITON-TIMI 38

Question 9

Contraindication of prasugrel

Answer 9

Prior stroke or TIA

Question 10

Mainstay of therapy for anticoagulation to be added to aspirin and clopidogrel for UA/NSTEMI

Answer 10

Unfractionated heparin

Question 11

In the early invasive strategy for UA/NSTEMI, coronary arteriography should be carried out within this number of hours from admission

Answer 11

48 hours

Question 12

Drugs recommended for long-term plaque stabilization

Answer 12

Beta blockers, high-dose statins, and ACE inhibitors or ARBs

Question 13

Diagnostic hallmark of Prinzmetal’s variant angina

Answer 13

Transient coronary spasm on angiography

Question 14

Most common location of focal spasm in Prinzmetal’s variant angina

Answer 14

Right coronary artery

Question 15

Agents/maneuvers used to provoke focal coronary stenosis on angiography to establish the diagnosis of Prinzmetal’s variant angina

Answer 15

Ergonovine, acetylcholine, hyperventilation

Question 16

Main agents used to treat acute episodes and abolish recurrent episodes of Prinzmetal’s variant angina

Answer 16

Nitrates and calcium channel blockers