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Cardiology Secrets > PERCUTANEOUS CORONARY INTERVENTION > Flashcards

PERCUTANEOUS CORONARY INTERVENTION Flashcards

1
Q

What does the term percutaneous coronary intervention mean?

A

A therapeutic coronary intervention that has become synonymous with coronary stent implantation

Initially referred to as percutaneous transluminal coronary angioplasty (PTCA), it includes various adjunct interventions like laser and atherectomies.

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2
Q

Who performed the first successful balloon angioplasty procedure in humans?

A

Andreas Gruentzig in 1977

This marked the beginning of significant advances in interventional cardiology.

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3
Q

What are drug-eluting stents (DESs)?

A

Stents that release medication to prevent restenosis, replacing bare-metal stents (BMSs) in PCI

DESs address many complications associated with older stent types.

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4
Q

What is plain old balloon angioplasty (POBA)?

A

Balloon angioplasty performed without stenting

This term distinguishes it from PCI, which typically involves stent placement.

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5
Q

How many percutaneous coronary interventions (PCI) are performed annually in the United States?

A

More than 500,000 procedures

PCI is a common medical procedure for coronary revascularization.

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6
Q

What are the goals of treatment in patients with coronary artery disease (CAD)?

A
  • Relieve symptoms
  • Prevent adverse outcomes such as cardiovascular death, myocardial infarction (MI), left ventricular dysfunctions, and arrhythmias

These goals guide the use of PCI and other treatments.

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7
Q

Which patients with chronic stable angina benefit from PCI?

A

Patients with unacceptable angina and significant coronary artery stenoses

These patients should not respond to two or more classes of antianginals.

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8
Q

What is the preferred treatment for patients with three-vessel CAD?

A

Coronary artery bypass grafting (CABG)

This is particularly true for complex or extensive CAD with a high SYNTAX score.

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9
Q

What are the two major strategies for treating non–ST-segment elevation acute coronary syndrome (NSTE-ACS)?

A
  • Conservative (medical therapy only)
  • Early invasive (catheterization and revascularization)

The choice of strategy depends on patient risk factors.

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10
Q

What factors favor an early invasive approach in NSTE-ACS patients?

A
  • Recurrent or refractory angina
  • Positive cardiac biomarkers
  • Dynamic ST-segment changes
  • Heart failure
  • Hemodynamic instability
  • Ventricular arrhythmias
  • High-risk scores

These factors help identify patients who may benefit most from PCI.

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11
Q

What is the only absolute contraindication to PCI?

A

Lack of vascular access or active untreatable severe bleeding

This condition precludes the use of anticoagulation and antiplatelet agents.

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12
Q

What are some relative contraindications to PCI?

A
  • Bleeding diathesis
  • Severe renal insufficiency
  • Sepsis
  • Poor patient compliance
  • Terminal condition
  • Anatomic features of low success
  • Severe cognitive dysfunction

These factors may increase the risks associated with the procedure.

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13
Q

What are the major complications related to PCI?

A
  • Death
  • Myocardial infarction (MI)
  • Stroke
  • Emergency CABG
  • Vascular complications
  • Complications of radial artery access

The incidence of these complications has decreased in recent years due to advancements in technology and techniques.

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14
Q

What laboratory values should be measured in post-PCI patients?

A
  • Troponin I or T
  • Complete blood count (CBC) if GpIIb-IIIa inhibitors are used
  • Renal function assessment

Routine measurement of cardiac biomarkers is not recommended for all PCI procedures.

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15
Q

What is abrupt vessel closure?

A

Complete occlusion of an artery within hours of the PCI procedure

Causes include stent thrombosis, dissection flap, vessel spasm, or side-branch occlusion.

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16
Q

What is stent thrombosis?

A

Complete occlusion of the artery due to thrombus formation in the stent

It can occur within different time frames post-implantation and is associated with high mortality rates.

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17
Q

What is the mortality rate associated with stent thrombosis?

A

20% to 45%

Stent thrombosis often presents as STEMI requiring emergency revascularization.

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18
Q

What is stent thrombosis?

A

A potentially catastrophic event often presenting as STEMI, requiring emergency revascularization.

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19
Q

What is the mortality rate associated with stent thrombosis?

A

20% to 45%.

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20
Q

What are the primary factors contributing to stent thrombosis?

A
  • Inadequate stent deployment
  • Incomplete stent apposition
  • Residual stenosis
  • Unrecognized dissection
  • Noncompliance with dual antiplatelet therapy (DAPT)
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21
Q

What is the most common cause of stent thrombosis?

A

Noncompliance with dual antiplatelet therapy (DAPT).

22
Q

What does the term ‘slow flow’ refer to?

A

Delayed clearing of contrast down the coronary artery.

23
Q

What does ‘no reflow’ mean?

A

An acute reduction in coronary flow in the absence of dissection, thrombosis, spasm, or high-grade stenosis.

24
Q

What are some causes of no reflow?

A
  • Vasospasm
  • Distal embolization
  • Microvascular plugging
25
Q

What treatment is recommended for no reflow?

A

Administering vasodilators such as adenosine, nicardipine, or nitroprusside.

26
Q

How do bleeding complications relate to percutaneous coronary intervention (PCI)?

A

They are an independent predictor of early and late mortality.

27
Q

What factors contribute to the risk of bleeding during PCI?

A
  • Advanced age
  • Low body mass index
  • Renal insufficiency
  • Anemia at baseline
  • Difficult vascular access
  • Site and condition of access vessel
  • Sheath size
  • Degree of anticoagulation and platelet inhibition
28
Q

What are potential complications of vascular access?

A
  • Retroperitoneal bleeding
  • Pseudoaneurysm
  • Arteriovenous fistula
  • Arterial dissection
  • Thrombosis
  • Distal artery embolization
  • Groin hematoma
  • Infection/abscess
  • Femoral neuropathy
29
Q

What is contrast-induced nephropathy (CIN)?

A

Worsening in renal function due to the administration of intravascular iodinated contrast.

30
Q

What are the predisposing factors for contrast-induced nephropathy (CIN)?

A
  • Chronic renal insufficiency
  • Diabetes
  • Congestive heart failure
  • Intravascular volume depletion
  • Multiple myeloma
  • Use of a large volume of contrast
31
Q

What is restenosis?

A

The recurrence of a treated coronary artery stenosis over time.

32
Q

What mechanisms drive the process of restenosis?

A
  • Neointimal hyperplasia
  • Platelet deposition and thrombus formation
  • Elastic recoil of a vessel
33
Q

What are the recommendations regarding antiplatelet therapy after PCI?

A
  • DAPT with aspirin and a P2Y12 inhibitor
  • Aspirin 81 mg daily post-PCI
  • P2Y12 loading doses before PCI
34
Q

What is the recommended duration of DAPT for patients undergoing elective DES implantation?

A

At least 6 months.

35
Q

What steps should be taken to prevent premature discontinuation of dual antiplatelet therapy?

A
  • Educate patients on the importance of continuing therapy
  • Instruct patients to call cardiologists if bleeding develops or if advised to stop therapy by another physician.
36
Q

What are common reasons for premature cessation of P2Y12 therapy?

A

Drug cost, inadequate patient and healthcare provider understanding, requests to discontinue therapy before noncardiac procedures.

37
Q

What should patients be educated about regarding P2Y12 therapy?

A

The rationale for not stopping antiplatelet therapy and the potential consequences of stopping.

38
Q

What should healthcare providers performing invasive procedures be aware of?

A

The potentially catastrophic risks of premature discontinuation of P2Y12 therapy.

39
Q

What is the recommended timing for elective procedures in relation to P2Y12 therapy?

A

Elective procedures should be deferred until patients have completed an appropriate course of P2Y12 therapy.

40
Q

What is the minimum duration for P2Y12 therapy after BMS implantation?

A

A minimum of 1 month.

41
Q

For patients with DESs undergoing procedures that require discontinuation of P2Y12 therapy, what should be continued?

A

Aspirin should be continued if at all possible.

42
Q

What is the recommendation for elective surgery in patients treated with DESs?

A

Elective surgery should be deferred for 6 months.

43
Q

What should be done if P2Y12 inhibitor therapy must be temporarily discontinued?

A

Consider discontinuation after 3 months if risk of further delay is greater than stent thrombosis risk.

44
Q

What should be done if antiplatelet therapy must be held for surgery?

A

Surgery should ideally be performed in an institution with a 24-hour catheterization laboratory.

45
Q

What is preferred in cases of stent thrombosis?

A

Emergency PCI is strongly preferred over thrombolysis.

46
Q

What are the factors used to calculate the Dual Antiplatelet Therapy score?

A

Age, current cigarette smoker, diabetes mellitus, MI at presentation, prior PCI or MI, stent diameter, paclitaxel-eluting stent, CHF or LVEF.

47
Q

What should be emphasized in discussions with patients before discharge after PCI?

A

Compliance with medications, especially adherence to dual antiplatelet therapy, healthy living, diet, exercise, and smoking cessation.

48
Q

What is the purpose of the dual antiplatelet therapy (DAPT) score?

A

To determine if patients may benefit from prolonged dual antiplatelet therapy.

49
Q

What is the recommendation for revascularization strategy in patients with myocardial infarction and multivessel disease?

A

Complete revascularization at the time of the index procedure or staged intervention on nonculprit vessels.

50
Q

Fill in the blank: The minimum duration for P2Y12 therapy after DES implantation is _______.

A

3 months.

51
Q

True or False: Aspirin should be discontinued if possible for patients requiring procedures that mandate P2Y12 therapy discontinuation.

A

False.

Cardiology Secrets (26 decks)

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