ACS Long Term Management and Special Populations

Question 1

Long term DAPT in ischemia-guided therapy

Answer 1

aspirin 80 mg plus either clopidogrel 75 mg daily or ticagrelor 90 mg twice daily should be continued for up to 12 months.

Question 2

Long term DAPT after PCI

Answer 2

(bare metal stent or drug-eluting stent), aspirin plus clopidogrel 75 mg daily, prasugrel 10 mg daily, or ticagrelor 90 mg twice daily at least 12 months
6 months duration for elective PCI

Question 3

β-Blockers duration ACS

Answer 3

at least 3 years (when EF is greater than 40%).
if moderate or severe LV failure, initiate carvedilol, bisoprolol, or metoprolol succinate with gradual titration. Continue indefinitely in patients with an EF less than 40%.

Question 4

Angiotensin-converting enzyme (ACE) inhibitors indication in ACS

Answer 4

initiated and continued indefinitely for all patients with an LVEF of 40% or less and in those with hypertension, diabetes mellitus, or stable chronic kidney disease, unless contraindicated

Question 5

Aldosterone receptor blockers ACS indication

Answer 5

patients who are already receiving an ACE inhibitor and β-blocker after MI and who have an LVEF of 40% or less and either symptomatic HF or diabetes

Question 6

Aldosterone receptor blockers Contraindications

Answer 6

hyperkalemia (potassium [K+] 5.0 or greater), CrCl less than 30 mL/minute, and SCr greater than 2.5 mg/dL in men and greater than 2.0 mg/dL in women

Question 7

Vaccination in ACS

Answer 7

Pneumococcal vaccination is recommended for patients 65 and older and in high-risk patients (including smokers with asthma) with CV disease.
An annual influenza vaccination is recommended for patients with CV disease.

Question 8

De-escalation time from triple to dual therapy in AF/ACS

Answer 8

Aspirin therapy can be discontinued at time of discharge or can be continued for 1–months, depending on risks. Triple therapy may be extended beyond hospital discharge for a limited time (i.e., 1–3 months) in select patients at the highest risk of ischemic events and lowest risk of bleeding

Question 9

Warfarin remains the drug of choice in AF/ACS

Answer 9

patients with mechanical heart valves and in those with moderate to severe mitral stenosis

Question 10

When is CABG preferred to PCI in older patients

Answer 10

particularly those with diabetes mellitus or complex three-vessel disease (e.g., SYNTAX score greater than 22)

Question 11

Women with NSTE-ACS strategies

Answer 11

high-risk features (e.g., troponin positive) should undergo an early invasive strategy
low-risk features should not undergo early invasive treatment because of the lack of benefit and the potential for harm