case selection Flashcards
(59 cards)
for cabg questions will you need to calc a complex score for the boards (ie TIMI, Syntax)
No
Dr Whites Key point re PCI and CABG?
suspend reality. Need to do what evidence suggests not what you would do.
Things that favor CABG
good targets, high complexity, med-high syntax score, insulin dependent DM, poor dapt compliance, coexisting valve dz, less comorbidiy
What is class I indication for revasc of SIHD? What is class IIa?
stenosis > 50% with limiting angina > 50% unresponsive to OMT. Stenosis > 50% with dypnes or CHF and > 10% LV ischemia
In SIHD what percentage of LV ischemia is signficant?
>10%
What is considered prognostically signficant disease if stable angina or silent ischemia
- Left main > 50% 2. Any LAD > 50% with documented ischemia or FFR <0.8 3. 2VD or 3 VD with LV dysfunction with ischemia or FFR < 0.80 4. Large area of ischemia > 10% 5. Remaining patent vessel > 50% with ischemia or + FFR
What is class III for revasc?
1VD, no LAD > 50%, no ischemia
When CABG based on the guidleines by bonow?
1VD pLAD, 2VD with PLAD 3VD syntax <22 CABG is I and PCI is IIa 3VD syntax > =22and Syntax > =22 then CABG class I and PCI class III LM isolated CABG class I (PCI IIa) LM + 2VD or 3VD Syntax < 32 CABG class I and PCI IIb, if syntax >=33 then pci falls to class III
Only time PCI gets a higher class rec then CABG
1VD or 2VD non prox LAD (CABG IIb and PCI I
3VD syntax score that matters LM syntax care
>=22 however PCI in 3vd is IIb so PCI is pretty much not going to be a choice you want to take <33 or >=33 (although again if additonal lesions you are going to want to choose cabg (only real time you are good is isolated LM dz)
PCI ____ symptoms but doesnt improve ____ in SIHD
reduces, surivival
PCI may ____ short term risk of MI, and does note ____ the long term risk of MI in SIHD
increase, lower
Medical therapy on the exam
you will have to acknowledge that medical therapy will be a key component of this.
what is higher in cabg than pci (2)
stroke and HD
what drives MACE post PCI compared to CABG
TVR, and MI
What 2 trials show the CABG is better than PCI in pts with insulin treated DM with CABG
Freedom (18.7% vs. 26.6% 5 years)and Syntax (5 year MACE PCI 46.5 and CABG 29.0%),
Culprit Shock showed what
higher frequency of mort and RRT
SAFARI STEMI trial
fem vs. Radial
No difference in 30 d mor, no difference in bleeding
STEMI going to cath lab what do gl say to do before
asa 162 to 325 asa
P2?Y12 - Plavix 600, PRasugrel 60, Ticag 180
Heparin or bival
Algorhytm for presenting to non pci capable
will the transfer to device time be less than 120 min then tx
if > then lyse
Need a regional system of stemi care rec I
When dont watn to lyse even if expected door to tx time >120 min (%)
Cardiogenic shoc
high ris features:CHF
? ant mi
Later presetnters > 4 hrs
CI
- what is goal to give fibrinolytic if decide to do so]
- post fibrinolysis tx?
30 min
always need tx for an angio
- no reperfusion or reocclusion urgent
- transfer for angio & revasc 3-24 hours
GL recs for rescue PCI
class I, 3x mort if didnt do this.
What antiplts to support pci after fibrinolyisis/
< 24 hours 300 mg and > 24 hours 600 , can also give prasugrel 60 mg if > 24 hours and fibrin specific and 48 hours if fibrin nonspe adgent
