Chronic Stable Angina Flashcards
What therapy should not be initiated in patients with SIHD?
Therapy with rosiglitazone
Level of Evidence: C
What is a reasonable A1C goal for patients with a short duration of diabetes and a long life expectancy?
7% or less
Level of Evidence B
What should high-risk patients with SIHD and diabetes mellitus be prescribed?
An ACE inhibitor
Supported by HOPE and EUROPA studies
What is recommended for a hypertensive patient with SIHD?
Treatment with an ACE inhibitor
Level of Evidence A
Is empagliflozin considered a first-line treatment for hyperglycemia?
No
It reduces blood pressure, hyperglycemia, and MACE
What is the gold standard for the diagnosis of CAD?
Coronary angiography
Despite limitations in grading stenosis
What do IVUS and OCT provide compared to angiography?
More precise information about stenosis severity and plaque morphology
Useful in assessing coronary artery disease
What are Class IIa indications for hybrid coronary revascularization?
Limitations to traditional CABG, lack of suitable graft conduits, unfavorable LAD artery for PCI
Hybrid revascularization aims to improve the risk–benefit ratio
What characterizes significant clinical stenosis in left main stenoses?
≥50% luminal diameter narrowing
In the worst view angiographic projection
What defines significant stenosis in other locations aside from the left main?
≥70% luminal diameter narrowing
Intermediate lesions with FFR ≤ 0.80 are also significant
What does FFR reveal about an intermediate LAD lesion?
It may be functionally significant
Indicates two-vessel disease without left-main or proximal LAD disease
What is the mortality benefit of revascularization in unprotected left main disease?
There is a mortality benefit from revascularization
Evidence supports improved mortality with PCI relative to CABG in low complexity cases
What is the indication for PCI in single-vessel proximal circumflex vessel disease?
To improve symptoms
Mortality benefits are not established for all cases
What does the SYNTAX score assess?
Complexity of coronary artery disease
Low complexity scores are associated with isolated left main or adjunctive single vessel disease
What are the outcomes of FFR measurements in vein grafts?
Data on the use of FFR in vein grafts are limited
FFR is well validated in native vessels
What is the next appropriate step for a patient whose symptoms do not meet criteria for typical angina?
Consider noninvasive stress testing
Exercise ECG is recommended due to low pretest probability of CAD
What did the BARI study demonstrate regarding angioplasty and bypass grafting?
Equivalent long-term survival among patients with multivessel disease
Superior survival with internal mammary grafts to LAD artery in diabetics
What is the general recommendation for CABG vs. PCI for diabetics with multivessel disease?
CABG is generally preferred
Supported by ACC and AHA guidelines
What is the clinical benefit of revascularization in patients with nonviable myocardium?
Limited clinical benefit
Patients with viable myocardium had better outcomes when revascularized
What is the indication for revascularization in one-vessel disease without proximal LAD involvement?
Revascularization is harmful
ACC/AHA Class III recommendation
What is the recommendation for revascularization in patients with one-vessel disease without proximal LAD involvement?
Harmful (ACC/AHA Class III)
In patients with two-vessel disease without proximal LAD involvement or extensive ischemia, what is the revascularization recommendation?
Uncertain benefit (ACC/AHA Class IIb)
When is revascularization not indicated?
If the patient has not received an adequate trial of medical therapy and has no demonstrable evidence of ischemia
What is the appropriate therapy for patients with CAD who have not received adequate medical therapy?
Guideline directed medical therapy with a statin
What were the findings of randomized trials comparing stenting or CABG in patients with multivessel disease?
Equivalent long-term survival observed
What demographic typically characterized patients in randomized trials of stenting or CABG?
Relatively young (age 60 years) with two-vessel disease and preserved ventricular function
What did the cost-effectiveness analysis of the BARI trial demonstrate?
Cost-effectiveness of CABG compared to angioplasty
In the context of PCI for left main lesions, what is the current guideline recommendation?
Favor CABG over PCI in suitable patients
What was a major determinant of outcome in comparing CABG to PCI in the SYNTAX study?
Complexity of disease
What is the ACC/AHA recommendation for revascularization of left main disease with PCI?
Upgraded from Class III to Class IIb when anatomy is suitable
What is the relationship between creatine kinase (CK) rise and adverse outcomes?
Linear relationship demonstrated
What troponin elevation level is associated with increased mortality?
Marked elevations (>5 times normal)
What did the MASS study demonstrate regarding survival for patients with LAD disease?
Comparable survival regardless of treatment (medical therapy, PCI, CABG)
What does the COURAGE study indicate about PCI vs. intense medical therapy?
Comparable outcomes in stable patients over 15 years
What is the recommendation for asymptomatic patients with high-risk features on nuclear stress study?
Coronary angiography for risk stratification
What is recommended for patients with a normal ECG and no prior MI?
Routine assessment of left ventricular function is not recommended (Class III)
What does a Duke treadmill score of +7 suggest?
Low annual risk of cardiovascular events (<1% per year)
What is the significance of a lesion with ≥50% luminal diameter narrowing?
Suggestive of functional significance
What is recommended for patients with significant left main disease?
CABG is recommended (Class I)
What is the recommended approach to stress testing after revascularization?
Stress testing with adjunctive imaging is recommended
What is the occlusion rate of SVGs within the first year after surgery?
Up to 22%
What is the occlusion rate of SVGs over 10 years?
40%
What is the recommendation regarding hormone replacement therapy for postmenopausal women?
Not recommended due to potential harm (Class IV)
What was the finding of the study regarding Vitamin E in cardiovascular event reduction?
Not found to be beneficial (Class III)
