Elective Coronary Intervention

Question 1

What is the effect of both a patent LIMA and three patent grafts on the potential benefit of a reoperation?

Answer 1

They reduce the potential benefit of a reoperation

Question 2

What is the CABG Guideline’s description of the effect of reoperation in terms of operative mortality?

Answer 2

Threefold increase

Question 3

Which diseases are risk factors for CABG mortality?

Answer 3

• Renal disease
• Cerebrovascular disease

Question 4

What has been demonstrated to be superior in multiple trials compared to aspirin alone or Coumadin as adjuncts to stenting?

Answer 4

DAPT (Dual Antiplatelet Therapy)

Question 5

What is the definition of Contrast-Induced Nephropathy (CIN)?

Answer 5

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

Question 6

What factors influence the risk for contrast-associated nephropathy?

Answer 6

• Timing of contrast administration
• Volume of contrast administered
• Preexisting kidney disease or diabetes

Question 7

What are the recommended measures to prevent contrast-induced nephropathy according to ACC guidelines?

Answer 7

• Hydration with normal saline
• Use of iso-osmolar contrast agents or low-osmolar contrast agents

Question 8

True or False: Chronic renal insufficiency is a PCI risk factor.

Answer 8

True

Question 9

What is the smallest diameter DES available commercially?

Answer 9

<2.25 mm

Question 10

What is the relationship between FFR values and interdependence of flow physiology?

Answer 10

Assessing FFR values for individual lesions can lead to inaccurate values due to the interdependence of flow physiology

Question 11

What does an immediate post-PCI FFR value of ≥0.90 indicate?

Answer 11

Associated with reduced rates of repeat interventions and MACE

Question 12

What should be considered when evaluating the appropriateness of PCI according to the 2017 Appropriate Use Criteria?

Answer 12

• Patient symptoms
• Optimal antianginal medical therapy
• Results of noninvasive imaging studies or intraprocedure physiologic assessment (i.e., FFR)

Question 13

What does a high SYNTAX score (≥33) indicate in terms of MACE for PCI?

Answer 13

Associated with significantly higher MACE for PCI compared to CABG

Question 14

What is the significance of the SYNTAX trial findings regarding PCI and CABG?

Answer 14

PCI failed to meet noninferiority criteria compared to CABG for the entire cohort

Question 15

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 _______.

Answer 15

noninvasive functional testing

Question 16

What is the recommendation for revascularization in the presence of left main stenosis according to published criteria?

Answer 16

Consideration of revascularization regardless of symptoms

Question 17

What is the definition of intermediate severity for coronary artery stenosis?

Answer 17

30% to 70%

Question 18

What is the recommended method for evaluating intermediate severity stenosis after stenting a severe lesion?

Answer 18

FFR (Fractional Flow Reserve)

FFR is used as an alternative to noninvasive functional testing to guide PCI.

Question 19

What was the primary finding of the FAME trial regarding FFR-guided PCI?

Answer 19

Lower rate of death, nonfatal MI, or repeat revascularization at 12 months

Question 20

What does CFR stand for and how is it measured?

Answer 20

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).

Question 21

What CFR value indicates a hemodynamically significant lesion?

Answer 21

Values below 2.0

Additionally, an FFR value ≤0.80 also indicates a hemodynamically significant lesion.

Question 22

True or False: FFR is unreliable in the presence of a prior myocardial infarction.

Answer 22

False

FFR is the most reliable measure even in the presence of a prior MI.

Question 23

What are the potential risks associated with adenosine administration during FFR measurement?

Answer 23

Risks include complications from adenosine administration

Several novel adenosine-free methods have been tested against traditional adenosine FFR.

Question 24

What is the TIMI risk score for a patient with a score of 5?

Answer 24

26% incidence of death, MI, or urgent revascularization within 14 days

Indicates a high-risk situation requiring invasive risk stratification.

Question 25

Which factors are major risk factors for bleeding complications in patients with ACS undergoing PCI?

Answer 25

• Age
• Female sex
• Renal insufficiency
• Low body weight

The patient in the case is overweight, which is not a risk factor.

Question 26

What is indicated for high-risk patients with acute coronary syndrome?

Answer 26

Revascularization of the presumed culprit artery

This is supported by a high TIMI risk score and significant stenosis findings.

Question 27

What do most retrospective studies support for true bifurcation lesions?

Answer 27

Provisional stenting of side branches

This strategy is supported by several studies.

Question 28

What are independent predictors of cumulative stent thrombosis?

Answer 28

• 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.

Question 29

What techniques can facilitate stent delivery through tortuous or calcified coronary arteries?

Answer 29

Various techniques, including avoiding deep throating of the guide catheter

Deep throating should be avoided to prevent trauma to proximal vessels.

Question 30

What does the updated 2017 Appropriate Use Criteria address in relation to revascularization?

Answer 30

Situations of revascularization in the setting of renal transplant

Revascularization can include either CABG or PCI.