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Invasive Cardiology Board Review > Percutaneous Coronary Intervention > Flashcards

Percutaneous Coronary Intervention Flashcards

1
Q

What does a minimal lumen area >7.5 m² in the left main coronary artery suggest according to the 2011 PCI guidelines?

A

Revascularization may be deferred

Reference: Levine GN, et al. J Am Coll Cardiol 2011;58(24):e44–e122.

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2
Q

What is the classification for CABG in patients with significant left main disease?

A

Class I indication

CABG is the preferred approach for significant left main disease.

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3
Q

What is the minimal lumen area range that requires further physiologic assessment according to the 2011 PCI guidelines?

A

Between 6 and 7.5 m²

This indicates the need for further evaluation.

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4
Q

What does a high SYNTAX score (≥33) indicate about a patient’s condition?

A

High complexity of coronary artery disease

This can impact treatment decisions.

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5
Q

What does the 2011 PCI guidelines state about PCI for non-LAD single-vessel disease?

A

Class III harm recommendation for improvement of survival

Reference: Levine GN, et al. J Am Coll Cardiol 2011;58(24):e44–e122.

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6
Q

True or False: The FAME 2 trial showed an overall reduction in the risk of MI or death with FFR-guided PCI.

A

False

Only a landmark analysis after 8 days showed some reduction.

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7
Q

What is the recommendation for DAPT duration in patients with stable ischemic heart disease undergoing second-generation DES implantation?

A

At least 6 months

This was updated from 12 months in the 2011 PCI guidelines.

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8
Q

What should be the management option for a patient with stable ischemic heart disease who does not have angina?

A

Continued current medical therapy

PCI is not indicated as it cannot improve symptoms.

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9
Q

Fill in the blank: In patients with stable ischemic heart disease, a minimal lumen diameter of >2.0 m² and minimal lumen area of >4.0 m² correlate with _______.

A

Low rates of ischemic events

Reference: Levine GN, et al. J Am Coll Cardiol 2011.

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10
Q

What is the recommendation for fibrinolytic therapy in STEMI patients within 12 hours of symptom onset?

A

Should be given if primary PCI cannot be performed within 120 minutes

Reference: O’Gara PT, et al. J Am Coll Cardiol 2013.

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11
Q

What does the 2011 ACC/AHA PCI guidelines state about PCI of a totally occluded infarct artery more than 24 hours after STEMI?

A

Should not be performed in asymptomatic patients

Class III—no benefit recommendation.

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12
Q

What is the recommendation for measuring serum cardiac biomarkers post-PCI?

A

Level of Evidence C, based on expert opinion

No studies have shown that measurement improves outcomes.

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13
Q

What is the Class IIa recommendation for CABG in single-vessel disease with a proximal LAD lesion?

A

Can be beneficial to improve survival

Reference: Hillis LD, et al. J Am Coll Cardiol 2011.

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14
Q

What two factors increase the risk of contrast nephropathy?

A
  • Diabetes
  • Pre-existing renal disease

Preprocedural hydration and minimization of contrast are recommended.

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15
Q

What prophylaxis should be given to patients with prior anaphylactoid reactions to contrast media?

A

Steroid and antihistamine

Reduces the risk of recurrent reaction to <1%.

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16
Q

True or False: Routine platelet function testing to screen patients treated with clopidogrel has shown benefit.

A

False

Both GRAVITAS and ARCTIC studies showed no benefit.

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17
Q

What is the recommendation regarding routine periodic stress testing of asymptomatic patients after PCI?

A

Should not be performed

Class III—no benefit.

18
Q

What does the 2014 SIHD guideline state about CABG for patients with diabetes and multivessel CAD?

A

Generally recommended instead of PCI to improve survival

Especially if a LIMA graft can be used.

19
Q

What was the outcome of the TAPAS study regarding routine manual aspiration thrombectomy?

A

Showed benefit, but subsequent studies did not

Larger studies like INFUSE-AMI, TASTE, and TOTAL failed to show benefit.

20
Q

What does the 2011 ACC/AHA/SCAI PCI guidelines state about routine prophylactic coronary revascularization before non-cardiac surgery?

A

Should not be performed

Class III—harm recommendation.

21
Q

What anticoagulant is recommended when patients treated with fondaparinux undergo PCI?

A

An anticoagulant with anti-IIa activity

Use of fondaparinux alone is not recommended (Class III—harm).

22
Q

What does the 2015 ACC/AHA primary PCI focused update state about PCI of a noninfarct artery at the time of primary PCI?

A

May be considered in selected patients

This is a revision from previous Class III harm recommendations.

23
Q

According to the 2016 ACC/AHA Duration of DAPT focused update, what is the standard DAPT duration for patients with SIHD treated with DES?

A

At least 6 months

A treatment period of 3 months may be reasonable in high bleeding risk patients.

24
Q

What is the standard DAPT duration for patients with SIHD treated with DES?

A

At least 6 months

A treatment period of 3 months may be reasonable in patients at high bleeding risk.

25
Q

What factors put a patient at higher bleeding risk?

A

GI bleeding, older age, CKD, anemia

CKD stands for chronic kidney disease.

26
Q

True or False: No study has shown the efficacy of antiplatelet monotherapy without concomitant oral anticoagulant therapy.

A

True

27
Q

What is the recommended strategy for preprocedural hydration and contrast agent dosing?

A

Decrease the risk of contrast nephropathy

N-acetylcysteine has not shown meaningful benefits regarding contrast nephropathy.

28
Q

What is associated with a reduction in periprocedural MI?

A

High-dose statin therapy started 7 days before PCI

29
Q

What is the recommendation for patients in severe heart failure or cardiogenic shock regarding angiography?

A

Immediate angiography

30
Q

What does the 2011 ACC/AHA/SCAI guideline suggest regarding the timing of angiography after fibrinolytic therapy?

A

3 to 24 hours after fibrinolytic therapy is reasonable for hemodynamically stable patients

31
Q

What is the strategy for a patient with ACS regarding antiplatelet therapy?

A

Continuing clopidogrel or using ticagrelor

Ticagrelor is recommended per the PLATO study.

32
Q

What medication should not be used in patients with a history of heparin-induced thrombocytopenia?

A

UFH (Unfractionated Heparin)

33
Q

What is recommended for patients undergoing PCI with a history of heparin-induced thrombocytopenia?

A

Bivalirudin

Bivalirudin is a direct thrombin inhibitor.

34
Q

What are the three recommendations regarding SVG PCI from the 2011 ACC/AHA/SCAI guidelines?

A
  • Platelet GP IIb/IIIa inhibitors are not beneficial
  • Embolic protection devices should be used when possible
  • PCI in chronic SVG occlusion is associated with low success rates

SVG stands for saphenous vein graft.

35
Q

What additional dose of IV enoxaparin is recommended at the time of PCI for patients with NSTE-ACS?

A

0.3 mg/kg

This is for patients who have received fewer than two therapeutic subcutaneous doses.

36
Q

What factors are associated with increased risk of stent thrombosis and recurrent spontaneous MI?

A
  • Diabetes
  • Continued smoking
  • Complex bifurcation stenting
  • Small stent diameter
37
Q

What should patients with a history of GI bleeding take while on DAPT?

A

PPI (Proton Pump Inhibitor)

38
Q

What does the 2016 ACC/AHA Duration of DAPT focused update recommend for patients treated with coronary stent implantation before CABG?

A

DAPT should be resumed or continued for the recommended duration

At least 1 year of therapy is recommended if the stent was placed for ACS.

39
Q

What is the first recommendation in the 2011 ACC/AHA/SCAI PCI guideline regarding revascularization?

A

A heart team approach for patients with unprotected left main or complex CAD

40
Q

True or False: The elective insertion of a hemodynamic support device as an adjunct to PCI is always recommended.

A

False

41
Q

What was concluded in the BCIS-1 study regarding IABP with PCI in high-risk patients?

A

No difference in primary composite endpoint between routine and provisional use

Invasive Cardiology Board Review (42 decks)

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