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Flashcards in Intervention Deck (32)
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1

What is the medical management of SCAD?

Beta blockers - reduces recurrent scad
Aspirin lifelong
Clopidogrel 12 months
Statin if dyslipidaemi

2

What are the indications for urgent revascularisation in SCAD?

Haemodynamic instability
Left main dissection
Ongoing ischaemia

3

What is the preferred method of revascularisation for SCAD if required?

Cabg

4

What is the mortality of SCAD?

4%

5

What is the rate of recurrent SCAD in 2 years?

13%-17%

6

What is the long term success rate of PCI for SCAD without complications?

30%

7

What are the ESC guidelines for Diagnosis of STEMI on ecg

Two contiguous leads >1mm (apart from V2-3)

V2-3
Men >40 years - >2mm
Men <40 years - >2.5mm
Women - >1.5mm

8

What are the ECG findings of NSTEACs as per ESC?

New horizontal/downsloping ST depression >0.5 in 2 contiguous leads

New t wave inversion >1mm in two contiguous leads with dominant R wave

9

How do you define post PCI MI based on the ESC?

20% increase in troponin with absolute value greater than 5 times the ULN

10

How do you define myocardial injury?

Rise in troponin without objective evidence of ischaemia.

Objective evidence:
Chest pain
Ecg changes
Echo findings
Angiographic evidence

11

What are the contraindications for ticagrelor?

Weight <60
COAD
Bradycardia
Liver dysfunction

12

What are the contraindications for prasugrel?

Stroke or TIA
Weight <60
Age >75
Asian

13

In conservatively managed NSTEAC what is the preferred method of anticoagulation?

Enoxaparin

Essence trial - lower rate of death MI and recurrent angina compared to heparin

14

What is the absolute reduction in MI and death in NSTEACS with anticoagulation?

3%

15

Definition of myocardial infarction.

Rise and fall in troponin with one value above the 99th percentile with one of the following

1. Symptoms of myocardial ischaemia
2. new ischaemic changes on ECG
3. Development of pathological q waves
4. Imaging evidence of loss of viable myocardium or new regional wall motion change
5. Coronary thrombus on angio or autopsy

16

What are the features that may distinguish Takotsubo Cardiomyopathy from Myocardial Infarction?

Regional wall motion abnormalities
QTC >500
Improvement in EF within 2 weeks

17

What is the specificity of sgarbossa criteria for MI?

99%

18

What is the ARR for mortality of ticagrelor over clopidogrel in patients ACS?

2% reduction in vascular and all cause mortality

19

In the setting of ACS with invasive strategy and prasugrel/ticagrelor DAPT, when are GP2b3a inhibitors recommended by ESC guidelines?

Bailout situations with thrombotic complications of PCI

20

What do meta analyses show regarding thrombectomy in the management of STEMI?

Overall no difference in mortality with and without thrombectomy with Increased stroke risk.

Trend towards improved mortality with manual aspiration thrombectomy (P = 0.05)

21

What is the ARR for MACE with ticagrelor over clopidogrel in medically managed ACS?

2.3%

22

How does heparin compare to enoxaparin in acute coronary syndromes?

Less death, MI and major bleeding with enoxaparin (Meta-analysis Silvain 2012)

23

What is the absolute risk reduction with anticoagulation for acute coronary syndromes?

2.9% (Meta-analysis Eikelboom 2000)

24

What did Oasis-5 show?

Fondaparinux (2.5mg sc OD) was superior to enoxaparin in bleeding risk and mortality at 1 and 6 months with non-inferiority in recurrent MI

25

What is the ARR for MI/Death of a routine invasive strategy over selective invasive strategy in low, moderate and high risk NSTEAC?

2, 4, 11%

26

What is the ARR for Death of a routine invasive strategy over selective invasive strategy in NSTEAC?

1.6%

27

In what setting is non-invasive stress testing indicated in ACS before deciding on an invasive strategy?

Low risk patients (No high/intermediate risk factors)
No recurrent symptoms

28

What are the high risk criteria in ACS?

Rise and fall in troponin - dynamic troponin
Dynamic ECG changes
Grace score >140

29

What are the intermediate risk criteria in ACS?

Diabetes
GFR <60
LVEF <40%
Post Infarct Angina
Prior revascularisation
Grace between 110 and 140

30

What syntax score is associated with worse mortality with PCI in ACS?

>8