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` > CAD: Treatment of Stable CAD > Flashcards

CAD: Treatment of Stable CAD Flashcards

1
Q

Limitations of trials comparing CABG to OMT

A

Predates ACEI, statins

ASA not used rot timely postop

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2
Q

3 subgroups of pt’s that had mortality benefit from CABG

A

3VD/LM or pLAD (esp w/ LV Dysfunction)
2VD w/ pLAD
Pt’s w/ greatest clinical risk: HTN, MI, bad angina, ST dep at rest

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3
Q

Class I indications for CABG in stable angina

A 
LM
LM Equiv (pLAD and pLCX)
3VD
2VD w/ pLAD AND ischemia or EF<50%
1VD w/ high risk stress or large area of viability 
Disabling angina on OMT
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4
Q

3 types of success post PCI

A

Angiographic ( 3x ULN)

Clinical (procedural + relief of si/sxs of ischemia)

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5
Q

Is post PCI restenosis a complication of PCI

A

No (normal vascular response to injury)

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6
Q

What % of PCI’s have a trop bump?

A

70%

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7
Q

Criteria for post PCI MI

A

2 of 3: bio markers, sxs, Q waves

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8
Q

On meta analysis, what were the benefits of PCI vs OMT?

A

Angina relief

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9
Q

What did BARI trial show in terms of angina?

A

CABG > PCI

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10
Q

What have trials shows for in hospital MI for PCI vs. CABG?

A

Higher In-hospital mortality with CABG

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11
Q

What is the difference in Late mortality in PCI vs CABG trials

A

No difference

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12
Q

What was difference b/w PCI and CABG for Late MI and Mortality?

A

No difference

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13
Q

What is the benefit for diabetics treated initially with CABG?

A

Decreased Mortality and MI

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14
Q

Why do diabetics have decreased mortality with CABG?

A

Less recurrent MI’s with IMA

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15
Q

What are the only 2 benefits of stents over POBA?

A

Reduce restenosis 50%

Reduce revascularization 40%

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16
Q

Was there a difference b/w PTCS and Stenting for death/MI/Emergent CABG?

A

No

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17
Q

What did ERACI-II trial show for CABG vs stent?

A

Functional revascularization was same

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18
Q

What did he ARTS, ERACI-II, and SOS trials show for stent vs. CABG?

A

Same death and MI

More revascularization w/ PCI

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19
Q

In a Meta-analysis if RCTs, what age group had the most mortality benefit from CABG over PCI?

A

> 65 yo

20
Q

Class I indications for PCI in chronic stable angina

A

None

21
Q

What percent of COURAGE subjects received DES?

A

2%

22
Q

Inclusion criteria for COURAGE

A

> =1V w/ 70% + ischemia (ECG or stress)
Or
80% stenosis + angina

23
Q

Exclusion criteria for COURAGE

A

CCS class IV
>50% LMCA
EF<30%
Refractory CHF

24
Q

COURAGE results

A

Mortality/MI- no difference

Angina free: PCI> OMT until 36 OM’s

25
Q

In what ways are DES superior to BMS?

A

Less late stent thrombosis

Less late MI (sirolimus< paclitaxel< BMS)

26
Q

Is there a difference b/w DES and BMS for mortality or emergent CABG?

A

No

27
Q

In pt’s w/ LM or 3VD, what was worse witCABG?

A

Stroke

28
Q

SYNTAX trial PICO and results

A

In pt’s w/ LMCA or 3VD, CABG had less MACCE than DES (Taxus). The MACCE was due to repeat revasc, as there was no difference in death or MI.

Note: nonsig trend towards lower all-cause mortality w/ CABG.

29
Q

Class I for cholesterol intake in chronic stable angina

A

Reduce saturated fats (<200mg/d cholesterol.

30
Q

Which beta receptor decreases HR?

A

B1

31
Q

Which beta receptor decreases afterload?

A

B2

32
Q

Why is carvedilol a good antihypertensive?

A

It blocks alpha 1 receptors

33
Q

Which beta receptors decrease contractility?

A

Beta 1 and 3

34
Q

After MI, how long should BB be cont’d if pt has Nl LVEF?

A

3 yrs

35
Q

BB that v an be used for CHF

A

Bisoprolol
Metoprolol succinate
Cavedilol

36
Q

Class I indications to improve survival with CABG

A

LM > 50%
sig stenosis in ANY 3V
Sig stenosis in pLAD and one other vessel

37
Q

Rate of vascular complications post PCI?

A

<1%

38
Q

In what case is angioplasty superior to OMT for stable CAD?

A

Angina relief

39
Q

Meds used in COURAGE

A

ASA or Plavix
Metoprolol, norvasc, +/- nitrates
Lisinopril or losartan
Simvastatin +/- ezetimibe

40
Q

BARI 2D conclusions

A

Overall mortality between OMT and CABG arms for DM and CAD pt’s was same. Lower CV events in CABG arm.

41
Q

Which has higher restenosis rates: paclitaxel or everolimus stents?

A

Paclitaxel

42
Q

At what syntax score do pt’s do better with cabg?

A

> 22

43
Q

FREEDOM trial results

A

In pt’s with DM and MV-CAD, CABG had lower mortality c/w DES

44
Q

3 findings of STICH trial

A
  • CABG does not reduce mortality in pt’s with stable CAD and LVEF<35% (but CABG had less death and CV hospitalization)
  • viability not helpful
  • LV reconstruction (SAVER) not helpful
45
Q

What class indication is it to give steroids or Benadryl pre cath for someone with shellfish allergy?

A

Class III

46
Q

Who should get ACEI in SIHD (class I)?

A

DM (HOPE trial)
HTN
CKD
EF< 40%

47
Q

~5yr mortality for pt’s w/ EF<35%

A

65%

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