CAD: Treatment of Stable CAD Flashcards
Limitations of trials comparing CABG to OMT
Predates ACEI, statins
ASA not used rot timely postop
3 subgroups of pt’s that had mortality benefit from CABG
3VD/LM or pLAD (esp w/ LV Dysfunction)
2VD w/ pLAD
Pt’s w/ greatest clinical risk: HTN, MI, bad angina, ST dep at rest
Class I indications for CABG in stable angina
LM LM Equiv (pLAD and pLCX) 3VD 2VD w/ pLAD AND ischemia or EF<50% 1VD w/ high risk stress or large area of viability Disabling angina on OMT
3 types of success post PCI
Angiographic ( 3x ULN)
Clinical (procedural + relief of si/sxs of ischemia)
Is post PCI restenosis a complication of PCI
No (normal vascular response to injury)
What % of PCI’s have a trop bump?
70%
Criteria for post PCI MI
2 of 3: bio markers, sxs, Q waves
On meta analysis, what were the benefits of PCI vs OMT?
Angina relief
What did BARI trial show in terms of angina?
CABG > PCI
What have trials shows for in hospital MI for PCI vs. CABG?
Higher In-hospital mortality with CABG
What is the difference in Late mortality in PCI vs CABG trials
No difference
What was difference b/w PCI and CABG for Late MI and Mortality?
No difference
What is the benefit for diabetics treated initially with CABG?
Decreased Mortality and MI
Why do diabetics have decreased mortality with CABG?
Less recurrent MI’s with IMA
What are the only 2 benefits of stents over POBA?
Reduce restenosis 50%
Reduce revascularization 40%
Was there a difference b/w PTCS and Stenting for death/MI/Emergent CABG?
No
What did ERACI-II trial show for CABG vs stent?
Functional revascularization was same
What did he ARTS, ERACI-II, and SOS trials show for stent vs. CABG?
Same death and MI
More revascularization w/ PCI