ACS/AMI III Flashcards
until how many days post MI do troponins remain elevated?
10d
Sn of troops 6h after onset of CP?
65%
which biomarker can quantitate the size of an infarct?
CK
CK onset, peak, normalization
6-10h after MI onset
peaks at 1d
resolves in 2-3d
causes of CKMB increase besides MI
CRF
GU/GI dz or Sx
marathons
how long after sxs onset does CKMB2 reliably rise?
6h
which trial made ASA in STEMI a Class I indication? (esp w/ A/C)
ISIS-2
what did meta-analysis show for primary PCI vs/ thrombolysis in STEMI
decrease mortality with PCI
if the STEMI sxs onset is <3h from arrival to ED, what is preferred strategy (PCI vs fibrinolysis)?
no preference unless contraindication or compelling indication (like Killip class III–> PCI)
Absolute contraindications to fibrinolytic Rx
ICH ischemic CVA within 3 mo's significant facial/head trauma within 3 mo's known brain lesion suspected Ao dissection active bleeding
wich fibrinolytic agent has the relatively best 90 min latency and TIMI 3 flow rates?
TNK
what are the only benefits of DES in STEMI?
less restenosis
less TVR at 1 yr
which trial (by G. Stone) showed that Taxus DES had significantly less TLR c/t BMS?
HORIZONS-AMI
which trial showed that there is no benefit to mortality with DES vs BMS?
HORIZONS-AMI
does aspiration thrombectomy in STEMI improve survival?
yes
which trial showed that there was no benefit to PCI of a totally occluded artery (c/w OMT)?
OAT
should you routinely transfer STEMI patients for PCI after TNK fibrinolysis? Which trial addressed this?
Yes!
TRANSFER-AMI
Name 3 subgroups that have atypical presentations or STEMI
women,elderly, diabetics
In Keeley’s metanalysis, what was the on,y disadvantage of PCI over thrombolysis?
PCI had more major bleeding
What do the new STEMI guidelines say about 90 mins?
It’s FIRST MEDICAL CONTACT to DEVICE TIME
If pt with STEMI comes to non-PCI center, how long can the FCM-device time be including transfer?
120min
What is an absolute contraindications specific to streptokinase?
Prior streptokinase in last 6 months
Is recent, internal bleeding an absolute contraindications to fibrinolytic therapy in STEMI?
No, relative
Which fibrinolytic agent has the most fibrin specificity?
TNK
Which fibrinolytic agent has the least fibrin specificity?
Streptokinase
