Coronary Artery Disease Flashcards
What is the treatment for STEMI?
Direct PCI if available (ideally <60min door to needle time)
If PCI centre available within 120min then transfer (preferably <90min)
If not available within 120min then thrombolyse and transfer to PCI centre
Failed thrombolysis - needs immediate PCI
Successful thrombolysis - do PCI 3-24hrs
PCI is favoured vs thrombolysis with regard to short term mortality
What are the absolute contraindications to thrombolysis?
Active bleeding or bleeding diathesis
Significant closed head or facial trauma within 3 months
Suspected aortic dissection
Any prior intracranial haemorrhage
Ischemic stroke within 3 months
Known structural cerebral vascular lesion e.g. AVM
Known malignant intracranial neoplasm (primary or metastatic)
What are the relative contraindications to thrombolysis?
Current use of anticoagulant Non-compressible vascular puncture Recent major surgery <3weeks Traumatic or prolonged >10min CPR Recent <4weeks internal bleeding (e.g. GI or GU) Active peptic ulcer Poorly controlled HTN Severe uncontrolled HTN >180/110 on presentation Ischemic stroke >3months ago Pregnancy
What are the contraindications of Prasugrel (newer anti-platelet)?
≥75yo, previous stroke/TIA, <60kg
Associated with high risk of bleeding
When can you stop DAPT safely?
Temporary cessation of DAPT in PCI patients is best after 6 months
If required okay to stop after 3 months
Do not stop before 30 days
What is the main mechanism by which beta blockers work in ACS?
Reduce myocardial oxygen demand (reduce preload and afterload)
Indications of CABG over PCI?
Left main stem disease with high syntax score >32
Proximal LAD stenosis >75% + other lesion (left circumflex or RCA)
Triple vessel disease especially if diabetic or LVEF <35% or high syntax score >32
Following NSTEMI which is the worst prognostic factor?
Reduced LV ejection fraction
What is the main risk of thrombolysis in STEMI?
Intracerebral hemorrhage
