Percutaneous Coronary Intervention Flashcards
What does a minimal lumen area >7.5 m² in the left main coronary artery suggest according to the 2011 PCI guidelines?
Revascularization may be deferred
Reference: Levine GN, et al. J Am Coll Cardiol 2011;58(24):e44–e122.
What is the classification for CABG in patients with significant left main disease?
Class I indication
CABG is the preferred approach for significant left main disease.
What is the minimal lumen area range that requires further physiologic assessment according to the 2011 PCI guidelines?
Between 6 and 7.5 m²
This indicates the need for further evaluation.
What does a high SYNTAX score (≥33) indicate about a patient’s condition?
High complexity of coronary artery disease
This can impact treatment decisions.
What does the 2011 PCI guidelines state about PCI for non-LAD single-vessel disease?
Class III harm recommendation for improvement of survival
Reference: Levine GN, et al. J Am Coll Cardiol 2011;58(24):e44–e122.
True or False: The FAME 2 trial showed an overall reduction in the risk of MI or death with FFR-guided PCI.
False
Only a landmark analysis after 8 days showed some reduction.
What is the recommendation for DAPT duration in patients with stable ischemic heart disease undergoing second-generation DES implantation?
At least 6 months
This was updated from 12 months in the 2011 PCI guidelines.
What should be the management option for a patient with stable ischemic heart disease who does not have angina?
Continued current medical therapy
PCI is not indicated as it cannot improve symptoms.
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 _______.
Low rates of ischemic events
Reference: Levine GN, et al. J Am Coll Cardiol 2011.
What is the recommendation for fibrinolytic therapy in STEMI patients within 12 hours of symptom onset?
Should be given if primary PCI cannot be performed within 120 minutes
Reference: O’Gara PT, et al. J Am Coll Cardiol 2013.
What does the 2011 ACC/AHA PCI guidelines state about PCI of a totally occluded infarct artery more than 24 hours after STEMI?
Should not be performed in asymptomatic patients
Class III—no benefit recommendation.
What is the recommendation for measuring serum cardiac biomarkers post-PCI?
Level of Evidence C, based on expert opinion
No studies have shown that measurement improves outcomes.
What is the Class IIa recommendation for CABG in single-vessel disease with a proximal LAD lesion?
Can be beneficial to improve survival
Reference: Hillis LD, et al. J Am Coll Cardiol 2011.
What two factors increase the risk of contrast nephropathy?
- Diabetes
- Pre-existing renal disease
Preprocedural hydration and minimization of contrast are recommended.
What prophylaxis should be given to patients with prior anaphylactoid reactions to contrast media?
Steroid and antihistamine
Reduces the risk of recurrent reaction to <1%.
True or False: Routine platelet function testing to screen patients treated with clopidogrel has shown benefit.
False
Both GRAVITAS and ARCTIC studies showed no benefit.
What is the recommendation regarding routine periodic stress testing of asymptomatic patients after PCI?
Should not be performed
Class III—no benefit.
What does the 2014 SIHD guideline state about CABG for patients with diabetes and multivessel CAD?
Generally recommended instead of PCI to improve survival
Especially if a LIMA graft can be used.
What was the outcome of the TAPAS study regarding routine manual aspiration thrombectomy?
Showed benefit, but subsequent studies did not
Larger studies like INFUSE-AMI, TASTE, and TOTAL failed to show benefit.
What does the 2011 ACC/AHA/SCAI PCI guidelines state about routine prophylactic coronary revascularization before non-cardiac surgery?
Should not be performed
Class III—harm recommendation.
What anticoagulant is recommended when patients treated with fondaparinux undergo PCI?
An anticoagulant with anti-IIa activity
Use of fondaparinux alone is not recommended (Class III—harm).
What does the 2015 ACC/AHA primary PCI focused update state about PCI of a noninfarct artery at the time of primary PCI?
May be considered in selected patients
This is a revision from previous Class III harm recommendations.
According to the 2016 ACC/AHA Duration of DAPT focused update, what is the standard DAPT duration for patients with SIHD treated with DES?
At least 6 months
A treatment period of 3 months may be reasonable in high bleeding risk patients.
What is the standard DAPT duration for patients with SIHD treated with DES?
At least 6 months
A treatment period of 3 months may be reasonable in patients at high bleeding risk.
What factors put a patient at higher bleeding risk?
GI bleeding, older age, CKD, anemia
CKD stands for chronic kidney disease.
True or False: No study has shown the efficacy of antiplatelet monotherapy without concomitant oral anticoagulant therapy.
True
What is the recommended strategy for preprocedural hydration and contrast agent dosing?
Decrease the risk of contrast nephropathy
N-acetylcysteine has not shown meaningful benefits regarding contrast nephropathy.
What is associated with a reduction in periprocedural MI?
High-dose statin therapy started 7 days before PCI
What is the recommendation for patients in severe heart failure or cardiogenic shock regarding angiography?
Immediate angiography
What does the 2011 ACC/AHA/SCAI guideline suggest regarding the timing of angiography after fibrinolytic therapy?
3 to 24 hours after fibrinolytic therapy is reasonable for hemodynamically stable patients
What is the strategy for a patient with ACS regarding antiplatelet therapy?
Continuing clopidogrel or using ticagrelor
Ticagrelor is recommended per the PLATO study.
What medication should not be used in patients with a history of heparin-induced thrombocytopenia?
UFH (Unfractionated Heparin)
What is recommended for patients undergoing PCI with a history of heparin-induced thrombocytopenia?
Bivalirudin
Bivalirudin is a direct thrombin inhibitor.
What are the three recommendations regarding SVG PCI from the 2011 ACC/AHA/SCAI guidelines?
- 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.
What additional dose of IV enoxaparin is recommended at the time of PCI for patients with NSTE-ACS?
0.3 mg/kg
This is for patients who have received fewer than two therapeutic subcutaneous doses.
What factors are associated with increased risk of stent thrombosis and recurrent spontaneous MI?
- Diabetes
- Continued smoking
- Complex bifurcation stenting
- Small stent diameter
What should patients with a history of GI bleeding take while on DAPT?
PPI (Proton Pump Inhibitor)
What does the 2016 ACC/AHA Duration of DAPT focused update recommend for patients treated with coronary stent implantation before CABG?
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.
What is the first recommendation in the 2011 ACC/AHA/SCAI PCI guideline regarding revascularization?
A heart team approach for patients with unprotected left main or complex CAD
True or False: The elective insertion of a hemodynamic support device as an adjunct to PCI is always recommended.
False
What was concluded in the BCIS-1 study regarding IABP with PCI in high-risk patients?
No difference in primary composite endpoint between routine and provisional use
