Chronic Stable Angina

Question 1

What therapy should not be initiated in patients with SIHD?

Answer 1

Therapy with rosiglitazone

Level of Evidence: C

Question 2

What is a reasonable A1C goal for patients with a short duration of diabetes and a long life expectancy?

Answer 2

7% or less

Level of Evidence B

Question 3

What should high-risk patients with SIHD and diabetes mellitus be prescribed?

Answer 3

An ACE inhibitor

Supported by HOPE and EUROPA studies

Question 4

What is recommended for a hypertensive patient with SIHD?

Answer 4

Treatment with an ACE inhibitor

Level of Evidence A

Question 5

Is empagliflozin considered a first-line treatment for hyperglycemia?

Answer 5

No

It reduces blood pressure, hyperglycemia, and MACE

Question 6

What is the gold standard for the diagnosis of CAD?

Answer 6

Coronary angiography

Despite limitations in grading stenosis

Question 7

What do IVUS and OCT provide compared to angiography?

Answer 7

More precise information about stenosis severity and plaque morphology

Useful in assessing coronary artery disease

Question 8

What are Class IIa indications for hybrid coronary revascularization?

Answer 8

Limitations to traditional CABG, lack of suitable graft conduits, unfavorable LAD artery for PCI

Hybrid revascularization aims to improve the risk–benefit ratio

Question 9

What characterizes significant clinical stenosis in left main stenoses?

Answer 9

≥50% luminal diameter narrowing

In the worst view angiographic projection

Question 10

What defines significant stenosis in other locations aside from the left main?

Answer 10

≥70% luminal diameter narrowing

Intermediate lesions with FFR ≤ 0.80 are also significant

Question 11

What does FFR reveal about an intermediate LAD lesion?

Answer 11

It may be functionally significant

Indicates two-vessel disease without left-main or proximal LAD disease

Question 12

What is the mortality benefit of revascularization in unprotected left main disease?

Answer 12

There is a mortality benefit from revascularization

Evidence supports improved mortality with PCI relative to CABG in low complexity cases

Question 13

What is the indication for PCI in single-vessel proximal circumflex vessel disease?

Answer 13

To improve symptoms

Mortality benefits are not established for all cases

Question 14

What does the SYNTAX score assess?

Answer 14

Complexity of coronary artery disease

Low complexity scores are associated with isolated left main or adjunctive single vessel disease

Question 15

What are the outcomes of FFR measurements in vein grafts?

Answer 15

Data on the use of FFR in vein grafts are limited

FFR is well validated in native vessels

Question 16

What is the next appropriate step for a patient whose symptoms do not meet criteria for typical angina?

Answer 16

Consider noninvasive stress testing

Exercise ECG is recommended due to low pretest probability of CAD

Question 17

What did the BARI study demonstrate regarding angioplasty and bypass grafting?

Answer 17

Equivalent long-term survival among patients with multivessel disease

Superior survival with internal mammary grafts to LAD artery in diabetics

Question 18

What is the general recommendation for CABG vs. PCI for diabetics with multivessel disease?

Answer 18

CABG is generally preferred

Supported by ACC and AHA guidelines

Question 19

What is the clinical benefit of revascularization in patients with nonviable myocardium?

Answer 19

Limited clinical benefit

Patients with viable myocardium had better outcomes when revascularized

Question 20

What is the indication for revascularization in one-vessel disease without proximal LAD involvement?

Answer 20

Revascularization is harmful

ACC/AHA Class III recommendation

Question 21

What is the recommendation for revascularization in patients with one-vessel disease without proximal LAD involvement?

Answer 21

Harmful (ACC/AHA Class III)

Question 22

In patients with two-vessel disease without proximal LAD involvement or extensive ischemia, what is the revascularization recommendation?

Answer 22

Uncertain benefit (ACC/AHA Class IIb)

Question 23

When is revascularization not indicated?

Answer 23

If the patient has not received an adequate trial of medical therapy and has no demonstrable evidence of ischemia

Question 24

What is the appropriate therapy for patients with CAD who have not received adequate medical therapy?

Answer 24

Guideline directed medical therapy with a statin

Question 25

What were the findings of randomized trials comparing stenting or CABG in patients with multivessel disease?

Answer 25

Equivalent long-term survival observed

Question 26

What demographic typically characterized patients in randomized trials of stenting or CABG?

Answer 26

Relatively young (age 60 years) with two-vessel disease and preserved ventricular function

Question 27

What did the cost-effectiveness analysis of the BARI trial demonstrate?

Answer 27

Cost-effectiveness of CABG compared to angioplasty

Question 28

In the context of PCI for left main lesions, what is the current guideline recommendation?

Answer 28

Favor CABG over PCI in suitable patients

Question 29

What was a major determinant of outcome in comparing CABG to PCI in the SYNTAX study?

Answer 29

Complexity of disease

Question 30

What is the ACC/AHA recommendation for revascularization of left main disease with PCI?

Answer 30

Upgraded from Class III to Class IIb when anatomy is suitable

Question 31

What is the relationship between creatine kinase (CK) rise and adverse outcomes?

Answer 31

Linear relationship demonstrated

Question 32

What troponin elevation level is associated with increased mortality?

Answer 32

Marked elevations (>5 times normal)

Question 33

What did the MASS study demonstrate regarding survival for patients with LAD disease?

Answer 33

Comparable survival regardless of treatment (medical therapy, PCI, CABG)

Question 34

What does the COURAGE study indicate about PCI vs. intense medical therapy?

Answer 34

Comparable outcomes in stable patients over 15 years

Question 35

What is the recommendation for asymptomatic patients with high-risk features on nuclear stress study?

Answer 35

Coronary angiography for risk stratification

Question 36

What is recommended for patients with a normal ECG and no prior MI?

Answer 36

Routine assessment of left ventricular function is not recommended (Class III)

Question 37

What does a Duke treadmill score of +7 suggest?

Answer 37

Low annual risk of cardiovascular events (<1% per year)

Question 38

What is the significance of a lesion with ≥50% luminal diameter narrowing?

Answer 38

Suggestive of functional significance

Question 39

What is recommended for patients with significant left main disease?

Answer 39

CABG is recommended (Class I)

Question 40

What is the recommended approach to stress testing after revascularization?

Answer 40

Stress testing with adjunctive imaging is recommended

Question 41

What is the occlusion rate of SVGs within the first year after surgery?

Answer 41

Up to 22%

Question 42

What is the occlusion rate of SVGs over 10 years?

Answer 42

40%

Question 43

What is the recommendation regarding hormone replacement therapy for postmenopausal women?

Answer 43

Not recommended due to potential harm (Class IV)

Question 44

What was the finding of the study regarding Vitamin E in cardiovascular event reduction?

Answer 44

Not found to be beneficial (Class III)