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Flashcards in CAD: Treatment of Stable CAD Deck (47):
0

~5yr mortality for pt's w/ EF<35%

65%

1

Limitations of trials comparing CABG to OMT

Predates ACEI, statins
ASA not used rot timely postop

2

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

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

3

Class I indications for CABG in stable angina

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

4

3 types of success post PCI

Angiographic ( 3x ULN)
Clinical (procedural + relief of si/sxs of ischemia)

5

Is post PCI restenosis a complication of PCI

No (normal vascular response to injury)

6

What % of PCI's have a trop bump?

70%

7

Criteria for post PCI MI

2 of 3: bio markers, sxs, Q waves

8

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

Angina relief

9

What did BARI trial show in terms of angina?

CABG > PCI

10

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

Higher In-hospital mortality with CABG

11

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

No difference

12

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

No difference

13

What is the benefit for diabetics treated initially with CABG?

Decreased Mortality and MI

14

Why do diabetics have decreased mortality with CABG?

Less recurrent MI's with IMA

15

What are the only 2 benefits of stents over POBA?

Reduce restenosis 50%
Reduce revascularization 40%

16

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

No

17

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

Functional revascularization was same

18

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

Same death and MI
More revascularization w/ PCI

19

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

>65 yo

20

Class I indications for PCI in chronic stable angina

None

21

What percent of COURAGE subjects received DES?

2%

22

Inclusion criteria for COURAGE

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

23

Exclusion criteria for COURAGE

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

24

COURAGE results

Mortality/MI- no difference
Angina free: PCI> OMT until 36 OM's

25

In what ways are DES superior to BMS?

Less late stent thrombosis
Less late MI (sirolimus< paclitaxel< BMS)

26

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

No

27

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

Stroke

28

SYNTAX trial PICO and results

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

Class I for cholesterol intake in chronic stable angina

Reduce saturated fats (<200mg/d cholesterol.

30

Which beta receptor decreases HR?

B1

31

Which beta receptor decreases afterload?

B2

32

Why is carvedilol a good antihypertensive?

It blocks alpha 1 receptors

33

Which beta receptors decrease contractility?

Beta 1 and 3

34

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

3 yrs

35

BB that v an be used for CHF

Bisoprolol
Metoprolol succinate
Cavedilol

36

Who should get ACEI in SIHD (class I)?

DM (HOPE trial)
HTN
CKD
EF< 40%

36

Class I indications to improve survival with CABG

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

37

Rate of vascular complications post PCI?

<1%

38

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

Angina relief

39

Meds used in COURAGE

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

40

BARI 2D conclusions

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

41

Which has higher restenosis rates: paclitaxel or everolimus stents?

Paclitaxel

42

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

> 22

43

FREEDOM trial results

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

44

3 findings of STICH trial

-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

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

Class III