Pocket Emergency Medicine (Pocket Notebook Series) 3rd Ed.

CARDIAC CATHETERIZATION

Indications

• ACS, high-risk stress test result or indeterminate result & high-risk or high PreTP for CAD, s/p cardiac arrest (SCD, VT), suspected nonatherosclerotic cause of ischemia (ie, spasm), systolic dysfxn of unclear etiology, or persistent angina despite tx or w/ systolic dysfxn

Types

• Balloon angioplasty: Effective but has unique cx: Coronary artery dissection & restenosis from vessel remodeling

• BMS: ↓ restenosis & repeat revasc (to ∼10% @ 12 mo) c/w balloon angioplasty but requires lifelong ASA & clopidogrel for at least 4 wk

• DES (NEJM 2006;354:483): ↓ restenosis (by ∼75%) & repeat revasc (by ∼50%); to <5% (by 12 mo); no Δ D/MI over 1 yr c/w BMS; requires lifelong ASA & clopidogrel for at least 1 yr (Circulation2007;115:813)



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