AHA Revascularization Guidelines Flashcards
What needs to be calculated for patient considering CABG?
STS Score
What are three risk factors not quantified in STS score but should be?
Cirrhosis- MELD
Frailty- Gait Speed
Malnutrition- MUST (Malnutrition Universal Screening Tool)
What are 3 Class 1 indications for PCI in STEMI?
- STEMI with < 12h and ischemic symptoms
- HD instability regardless of time
- Failed reperfusion
What are 2 class 2a indications for PCI in STEMI?
- STEMI lysed within 3-24h
- Stable STEMI 12-24 hours
What two scenarios should CABG not be done in failed PCI for STEMI?
- No feasible due to a no-flow state or poor distal targets
- In the absence of ischemia or a large area of myocardium at risk
What is Class 1 indication for non culprit PCI in STEMI? Class III?
- Class 1: Stable patients, staged PCI of significant non-infarct artery
- Class 3: Unstable patient
What 3 class 1 indications for Early invasive strategy in NSTEACS?
- High risk by GRACE (> 140) or TIMI (>2)
- Unstable
- Refractory Chest pain
What are 2 class 1 indications for revascularization in SIHD to improve survival?
- Multivessel CAD with LVEF < 35% (CABG)
- LMCA (CABG)
What is the only Class 1 indication for revascularization in SIHD for symptoms?
Refractory angina on medical therapy
How long should CABG be delayed in renal patients post Cath?
> 24 hours
4 measures to reduce risk of CIN?
- Assess risk of CIN before procedure
- Administer adequate preprocedural hydration
- Minimize contrast
- USe radial artery if feasible
What ate 3 benefits of Radial approach compared to femoral?
- Less bleeding
- Less arterial injury
- Lower mortality
What anticoagulant should be used in treating ACS?
-UFH
What kind of graft is preferred when grafting the second most important artery?
-Radial (As opposed to saphenous)
What are 5 measures to reduced sternal wound infection in CABG?
- Staph testing with nasal swab
- Apply 2% mupirocin ointment to known nasal carriers of S. Aureus
- Measuer perioperative Hbac1
- Smoking cessation
- Apply vancomycin to the cut edges of the stenrum on opening
- Treat all extrathoracic infections before non emergency surgical coronary revascularization
When to start aspirin post CABG?
6 hours post (325mg)
Name 1 class 3 indication for revascularization in STEMI
STEMI > 24 hours with no ischemic symptoms
3 populations with NSTEACS to proceed with Emergency Revascularization?
- HD Unstable/Cardiogenic Shock
- Electrical Instability
- Refractory Chest Pain
What population to perform early invasive strategy (< 24h) as opposed to emergent/Immediate?
High risk of Ischemic events but stable (GRACE > 140)
3 beneficial outcomes in those with early invasive strategy in high risk?
- Less recurrent ischemic event
- Less need for urgent revascularization
- Less hospital stay
3 class 1 indications for CABG in SIHD?
- LVEF < 35% and multivessel CAD
- Symptomatic LMCA
- Multivessel CAD with DM
What to do with LVEF 35-50% and multivessel SIHD?
CABG (Class 2a)
What should patients get for 1 year post CABG with Radial Artery use?
CCB for 1 year
3 non pharm interventions post revasc?
- Stress reduction
- Cardiac Rehab
- Smoking Cessation
