Periprocedural Myocardial Infarction, Emboli Protection, and Mechanical Thrombectomy Flashcards
What is the major mechanism for periprocedural myocardial infarction (MI)?
Embolization of microscopic debris with subsequent platelet activation and inflammation leading to impairment in microvascular flow
This mechanism highlights the importance of preventing embolic events during procedures.
What is required for distal embolic protection devices to function effectively?
A distal landing zone in the saphenous vein graft (SVG)
Without a safe landing zone, effective placement of devices like filter wires is not possible.
True or False: The Proxis proximal protection system is currently available in the United States.
False
The Proxis system was formerly an option but is no longer commercially available.
What was the significant finding of the randomized trial of a distal embolic protection (DEP) device during PCI of saphenous vein aortocoronary bypass grafts?
A significant reduction in the composite endpoint of death, MI, emergency bypass, or target lesion revascularization at 30 days
The reduction was mainly driven by lower rates of MI and the ‘no-reflow’ phenomenon.
What was the dosage of atorvastatin used in the ARMYDA trial, and what was its effect?
40 mg/day administered 7 days before elective coronary intervention reduced myocardial injury markers
This trial showed significant reductions in CK-MB, troponin I, and myoglobin levels.
Fill in the blank: In the SAFER trial, the use of distal protection devices resulted in a ______% relative risk reduction in the primary endpoint.
42
The primary endpoint was a composite of death, MI, emergency bypass, or target lesion revascularization by 30 days.
What factors are believed to increase the risk of periprocedural myonecrosis?
- Genetic predisposition
- Aspirin and clopidogrel resistance
- Increased arterial inflammation
These factors play a crucial role in the development of myonecrosis during procedures.
What is the relationship between periprocedural MI and mortality according to the EPIC trial?
A direct relationship between the degree of CK elevation post-procedure and 3-year mortality
Higher CK levels post-procedure correlate with increased mortality rates.
What did the TAPAS trial demonstrate regarding manual aspiration during primary PCI?
Manual aspiration was superior to conventional treatment for improving myocardial blush grade
However, it did not show a significant difference in ‘hard’ clinical outcomes.
What was the MACE rate with the use of current embolic protection devices (EPDs)?
7% to 12% depending upon the device
This rate varies among different studies examining the effectiveness of EPDs.
True or False: The association between periprocedural MI and PCI has been linked to increased stroke risk.
False
Numerous studies have established the association with mortality but not with stroke risk.
What are independent predictors of periprocedural MI identified in a retrospective study?
- Bifurcation lesions
- Multivessel procedures
- Overall lesion treated length
These factors contribute significantly to the risk of MI during procedures.
What is the primary endpoint of the EMERALD trial?
ST-segment resolution measured 30 minutes after PCI
The trial aimed to compare the efficacy of balloon occlusion and aspiration distal microcirculatory systems against angioplasty without distal protection.
What catheter is the smallest among the ones mentioned, and what is its tip diameter?
Pronto LP with a tip diameter of 1.34 mm
This catheter is compatible with 6-Fr guides.
What is the effect of nitroglycerin in microvascular arterioles?
Less effective than other options due to inability to metabolize effectively
Sodium nitroprusside is more effective because it acts directly.
What is the significance of ST-segment resolution greater than 70%?
Indicates improvement in myocardial function
ST-segment resolution is a key indicator of myocardial recovery after ischemic events.
What was the outcome of the REMEDIA study regarding thrombus aspiration prior to PCI?
Improvement in myocardial blush score and ST resolution compared to PCI alone
This suggests that thrombus aspiration may enhance the effectiveness of PCI.
What did the AIMI trial evaluate and what were its findings?
Evaluated 480 patients and failed to show significant difference in ST resolution
The trial indicated that thrombectomy may not improve outcomes as expected.
What was observed in patients who underwent thrombectomy in the AIMI trial?
Larger infarct size and higher 1-month MACE rate
MACE stands for major adverse cardiac events.
What does the BOOST trial focus on?
Intracoronary autologous bone-marrow cell transfer after myocardial infarction
BOOST trial did not test thrombus aspiration.
Fill in the blank: The TAPAS trial has been described _______.
[previously or elsewhere]
The specific details of the TAPAS trial were not included in the provided text.
