Elective Coronary Intervention Flashcards
What is the effect of both a patent LIMA and three patent grafts on the potential benefit of a reoperation?
They reduce the potential benefit of a reoperation
What is the CABG Guideline’s description of the effect of reoperation in terms of operative mortality?
Threefold increase
Which diseases are risk factors for CABG mortality?
- Renal disease
- Cerebrovascular disease
What has been demonstrated to be superior in multiple trials compared to aspirin alone or Coumadin as adjuncts to stenting?
DAPT (Dual Antiplatelet Therapy)
What is the definition of Contrast-Induced Nephropathy (CIN)?
Impairment of renal function defined as either a 25% increase in serum creatinine from baseline or a 0.5 mg/dL absolute increase typically within 48 to 72 hours after IV contrast administration
What factors influence the risk for contrast-associated nephropathy?
- Timing of contrast administration
- Volume of contrast administered
- Preexisting kidney disease or diabetes
What are the recommended measures to prevent contrast-induced nephropathy according to ACC guidelines?
- Hydration with normal saline
- Use of iso-osmolar contrast agents or low-osmolar contrast agents
True or False: Chronic renal insufficiency is a PCI risk factor.
True
What is the smallest diameter DES available commercially?
<2.25 mm
What is the relationship between FFR values and interdependence of flow physiology?
Assessing FFR values for individual lesions can lead to inaccurate values due to the interdependence of flow physiology
What does an immediate post-PCI FFR value of ≥0.90 indicate?
Associated with reduced rates of repeat interventions and MACE
What should be considered when evaluating the appropriateness of PCI according to the 2017 Appropriate Use Criteria?
- Patient symptoms
- Optimal antianginal medical therapy
- Results of noninvasive imaging studies or intraprocedure physiologic assessment (i.e., FFR)
What does a high SYNTAX score (≥33) indicate in terms of MACE for PCI?
Associated with significantly higher MACE for PCI compared to CABG
What is the significance of the SYNTAX trial findings regarding PCI and CABG?
PCI failed to meet noninferiority criteria compared to CABG for the entire cohort
Fill in the blank: The 2009 Focused Update to the PCI guidelines gives a Class IIa recommendation to use intracoronary physiologic measurements (i.e., FFR) as an alternative to _______.
noninvasive functional testing
What is the recommendation for revascularization in the presence of left main stenosis according to published criteria?
Consideration of revascularization regardless of symptoms
What is the definition of intermediate severity for coronary artery stenosis?
30% to 70%
What is the recommended method for evaluating intermediate severity stenosis after stenting a severe lesion?
FFR (Fractional Flow Reserve)
FFR is used as an alternative to noninvasive functional testing to guide PCI.
What was the primary finding of the FAME trial regarding FFR-guided PCI?
Lower rate of death, nonfatal MI, or repeat revascularization at 12 months
What does CFR stand for and how is it measured?
Coronary Flow Reserve; measured distal to a lesion before and after vasodilation
CFR is the ratio of flow distal to a lesion before and after vasodilation (Qdil/Qinitial).
What CFR value indicates a hemodynamically significant lesion?
Values below 2.0
Additionally, an FFR value ≤0.80 also indicates a hemodynamically significant lesion.
True or False: FFR is unreliable in the presence of a prior myocardial infarction.
False
FFR is the most reliable measure even in the presence of a prior MI.
What are the potential risks associated with adenosine administration during FFR measurement?
Risks include complications from adenosine administration
Several novel adenosine-free methods have been tested against traditional adenosine FFR.
What is the TIMI risk score for a patient with a score of 5?
26% incidence of death, MI, or urgent revascularization within 14 days
Indicates a high-risk situation requiring invasive risk stratification.
Which factors are major risk factors for bleeding complications in patients with ACS undergoing PCI?
- Age
- Female sex
- Renal insufficiency
- Low body weight
The patient in the case is overweight, which is not a risk factor.
What is indicated for high-risk patients with acute coronary syndrome?
Revascularization of the presumed culprit artery
This is supported by a high TIMI risk score and significant stenosis findings.
What do most retrospective studies support for true bifurcation lesions?
Provisional stenting of side branches
This strategy is supported by several studies.
What are independent predictors of cumulative stent thrombosis?
- Premature cessation of antiplatelet therapy
- Renal failure
- Bifurcation stenting
- Diabetes
- LV dysfunction
Age was a univariate predictor but not independently associated with stent thrombosis after adjustment.
What techniques can facilitate stent delivery through tortuous or calcified coronary arteries?
Various techniques, including avoiding deep throating of the guide catheter
Deep throating should be avoided to prevent trauma to proximal vessels.
What does the updated 2017 Appropriate Use Criteria address in relation to revascularization?
Situations of revascularization in the setting of renal transplant
Revascularization can include either CABG or PCI.
