CAD: Treatment of Stable CAD

Question 1

Limitations of trials comparing CABG to OMT

Answer 1

Predates ACEI, statins

ASA not used rot timely postop

Question 2

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

Answer 2

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

Question 3

Class I indications for CABG in stable angina

Answer 3

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

Question 4

3 types of success post PCI

Answer 4

Angiographic ( 3x ULN)

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

Question 5

Is post PCI restenosis a complication of PCI

Answer 5

No (normal vascular response to injury)

Question 6

What % of PCI’s have a trop bump?

Answer 6

70%

Question 7

Criteria for post PCI MI

Answer 7

2 of 3: bio markers, sxs, Q waves

Question 8

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

Answer 8

Angina relief

Question 9

What did BARI trial show in terms of angina?

Answer 9

CABG > PCI

Question 10

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

Answer 10

Higher In-hospital mortality with CABG

Question 11

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

Answer 11

No difference

Question 12

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

Answer 12

No difference

Question 13

What is the benefit for diabetics treated initially with CABG?

Answer 13

Decreased Mortality and MI

Question 14

Why do diabetics have decreased mortality with CABG?

Answer 14

Less recurrent MI’s with IMA

Question 15

What are the only 2 benefits of stents over POBA?

Answer 15

Reduce restenosis 50%

Reduce revascularization 40%

Question 16

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

Answer 16

No

Question 17

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

Answer 17

Functional revascularization was same

Question 18

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

Answer 18

Same death and MI

More revascularization w/ PCI

Question 19

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

Answer 19

> 65 yo

Question 20

Class I indications for PCI in chronic stable angina

Answer 20

None

Question 21

What percent of COURAGE subjects received DES?

Answer 21

2%

Question 22

Inclusion criteria for COURAGE

Answer 22

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

Question 23

Exclusion criteria for COURAGE

Answer 23

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

Question 24

COURAGE results

Answer 24

Mortality/MI- no difference

Angina free: PCI> OMT until 36 OM’s

Question 25

In what ways are DES superior to BMS?

Answer 25

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

Question 26

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

Answer 26

No

Question 27

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

Answer 27

Stroke

Question 28

SYNTAX trial PICO and results

Answer 28

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.

Question 29

Class I for cholesterol intake in chronic stable angina

Answer 29

Reduce saturated fats (<200mg/d cholesterol.

Question 30

Which beta receptor decreases HR?

Answer 30

B1

Question 31

Which beta receptor decreases afterload?

Answer 31

B2

Question 32

Why is carvedilol a good antihypertensive?

Answer 32

It blocks alpha 1 receptors

Question 33

Which beta receptors decrease contractility?

Answer 33

Beta 1 and 3

Question 34

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

Answer 34

3 yrs

Question 35

BB that v an be used for CHF

Answer 35

Bisoprolol Metoprolol succinate Cavedilol

Question 36

Class I indications to improve survival with CABG

Answer 36

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

Question 37

Rate of vascular complications post PCI?

Answer 37

<1%

Question 38

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

Answer 38

Angina relief

Question 39

Meds used in COURAGE

Answer 39

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

Question 40

BARI 2D conclusions

Answer 40

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

Question 41

Which has higher restenosis rates: paclitaxel or everolimus stents?

Answer 41

Paclitaxel

Question 42

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

Answer 42

> 22

Question 43

FREEDOM trial results

Answer 43

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

Question 44

3 findings of STICH trial

Answer 44

- 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

Question 45

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

Answer 45

Class III

Question 46

Who should get ACEI in SIHD (class I)?

Answer 46

DM (HOPE trial) HTN CKD EF< 40%

Question 47

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

Answer 47

65%