A 74-year-old man was hospitalized for a subacute MI. He presented 1 week prior to admission one episode of chest pain lasting 3 hours but he did not seek medical attention. The ECG at admission revealed deep Q waves and persisting ST-segment elevation in the anterior leads. The angiography showed a total occlusion of the proximal left anterior ascending coronary artery.
Which statement about the benefit of revascularization in this particular patient does apply?
PCI does not reduce the occurrence of death, reinfarction, or heart failure. The Occluded Artery Trial (OAT) study showed high rates of procedural success with PCI and sustained patency but no clinical benefit during an average 3-year follow-up with respect to death, reinfarction, or heart failure. There was, in fact, a trend toward excess nonfatal reinfarction when routine PCI was performed in stable patients who were found to have occlusion of the infarct-related artery 3 to 28 days after MI. A strategy of CABG was not tested in the OAT.
A 60-year-old man with a history of PCI 3 years previously asks for your advice with respect to his pharmacologic treatment. He is asymptomatic and his CV risk factors include smoking, hypertension, hypercholesterolemia, and impaired glucose tolerance. His medications include aspirin, atorvastatin, metoprolol, metformin, and lisinopril. His friend told him that clopidogrel should be added to his regimen.
What is the correct statement about that suggestion in this particular patient?
Answers a and d are correct. In the CHARISMA trial of 15,603 patients with established stable atherothrombotic disease or at high risk for such disease, there was no significant benefit associated with clopidogrel plus aspirin as compared with placebo plus aspirin in reducing the incidence of the primary endpoint of MI, stroke, or death from CV causes. Clopidogrel was associated with a significant increase in the rate of moderate bleeding.
A 60-year-old woman was discharged after an MI. Pharmacologic secondary prevention with antiplatelet agents, statins, β-blockers, and angiotensinconverting enzyme inhibitors is associated with:
Significant survival advantage. A cohort study of approximately 1,400 patients demonstrated that the use of combination evidence-based medical therapies was independently and strongly associated with lower 6-month mortality in patients with ACSs. Furthermore, there was a gradient of benefit across the different TIMI risk groups with higher-risk patients obtaining higher absolute benefit. The 2013 AHA/ACCA STEMI guidelines recommend:
A 55-year-old man presents since 3 months typical chest pain at moderate exertion. The angiography revealed single-vessel disease. An optimal therapy has been started; what is the benefit of a treatment with PCI of the culprit lesion?
PCI may reduce the episodes of angina in the presence of moderate-tosevere ischemia at stress single-photon emission computed tomography (SPECT) but not the risk of death, MI, or other major CV events when added to optimal medical therapy. The COURAGE trial compared OMT alone or in combination with PCI as an initial management strategy in patients with stable CAD. Although the addition of PCI to OMT reduced the prevalence of angina, especially in case of moderate-to-severe ischemia detected by SPECT, it did not reduce long-term rates of death, nonfatal MI, and hospitalization for ACSs.
A 67-year-old man known for hypertension and hypercholesterolemia presented significant ST elevation in inferoposterior leads during the treadmill test. The angiogram shows (Fig. below)
Severe RCA stenosis. Coronary angiography shows severe mid-RCA stenosis explaining the inferior ischemia.
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