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Cardiology EECC > Coronary Disease > Flashcards

Coronary Disease Flashcards

1
Q

Management of Suspected NSTE-ACS

A
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2
Q

Approach to patients with suspected angina and coronary disease

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3
Q

Diagnsostic tests in patients suspected of CAD

A
  • Non-invasive functional imaging for myocardial ischaemia or CTCA is recommended as an initial imaging test in patients in whom obstructive CAD can not be excluded based on clinical assessment alone
  • Choose functional vs CT based on clinical likelihood of CAD (higher likelihood functional, lower likelihood CTCA), characteristics that influence test performance and local expertise and availability
  • Funcitonal imaging recommended when CT shows CAD of uncertain significance or is non-diagnostic
  • Invasive coronary angiography is recommended as an alternative if:
    1. High clinical likelihood of CAD
    2. Severe symptoms refractory to medical therapy
    3. Typical angina on low level of exercise
    4. Clinical evaluation indicates high event risk

Invasive functional testing must be available and used to evaluate a stenosis unless very high grade (≥90%)

  • Consider invasive angiogram if uncertain diagnosis on non-invasive testing
  • Consider CTCA if other non-invasive test is non-diagnostic
  • Coronary calcium scoring not recommended to identify patients with obstructive CAD
  • Avoid CTCA when extensive coronary calcification, irregular heart rhythm, significant obestiy, inability to follow breath hold commands
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4
Q

Exercise Testing in Suspected CAD

A

ETT recommended for assessment of:
* Exercise tolerance
* Symptoms
* BP response to exercise
* Arrhythmias
* Event risk in selected patients

Consider ETT when other non-invasive modalities not available
Consider ETT to assess control of symptoms and ischaemia
Avoid if 0.1ms ST depression on resting ECG or digoxin treatment

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5
Q

Factors which reduce pre-test probability of CAD

A
  • No coronary calcium on CT
  • Normal exercise ECG
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6
Q

Factors which increase pre-test probability of CAD

A
  • CV risk factors: diabetes, hyperlipidaemia, smoking, HTN, FHx
  • Resting ECG changes: Q waves, TWI, ST depression
  • LV dysfunction suggestive of CAD
  • Abnormal exercise ECG
  • Coronary calcium on CT
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7
Q

Diagnostic Pathways in Symptomatic Patients Suspected of CAD

A
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8
Q

Definition of High Event Risk in Suspected CAD

A

According to Different Imaging Modalities

  • ETT - ≥3% cardiovascular mortality by Duke treadmill score
  • PET - ≥10% LV myocardium ischaemic
  • Stress echocardiography ≥3 segments with stress induced hypkinesia or akinesia
  • Stress MRI ≥2 segments with a stress perfusion defect or ≥3 dysfunctional segments at dobutamine stress
  • Coronary CT or IC: 3 vessel disease with proximal stenoses, left main disease or proximal LAD

Definition of High and Low Risk

High Risk Defined as >3% annual cardiovascular mortality risk
Lowe Risk Defined as <1% annual cardiovascular mortality risk

Recommendations
* Stratify risk based on initial imaging modality used to diagnose CAD
* Resting echo recommended in all patients with suspected CAD
* Risk stratifiction, preferably using functional imaging or CTCA, or ETT when others not available and the patient can exercise, is recommended in patients with suspected or newly diagnosed CAD
* In symptomatic patients with high risk profile, invasive coronary angiogram with FFR is recommended, particularly if symptoms refractory to medical treatment or revascularisation indicated for prognosis
* FFR/iFR recommended in patients with no or mild symptoms with high event risk to guide revascularisation for prognosis
* FFR can be used for risk stratification in patients with inconclusive stress imaging
* If CTCA used for risk stratification, if no/few symptoms, do stress imaging before referral for angiogram
* GLS adds incremental information compared with LVEF and shiould be considered when LVEF ≥35%
* IVUS should be considered in intermediate LMS stenosis

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9
Q

Anti-ischaemic drug therapy in CCS

A

If low HR and low BP, consider Ranolazine or Trimetazadine first line
Avoid nitrates in HOCM and with with phosphodiesterase inhibitors

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10
Q

Antithrombotic therapy recommendations: CCS and Sinus Rhythm

A
  • Aspirin 75mg recommended if previous MI or revascularisation (1a)
  • Clopidogrel is an alternative to aspirin if intolerant
  • Clopidogrel should be considered in preference to aspirin if PAD or previous TIA/stroke
  • Consider aspirin in patients without history of MI or revascularisation but definite imaging evidence of CAD
  • Consider adding second antiplatelet drug for long term secondary prevention in patients at high (IIa) or moderate (IIb) event risk of ischaemic events and without high bleeding risk
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11
Q

Antithrombotic therapy - CCS and sinus rhythm, Post PCI

A
  • Aspirin 75mg recommended
  • Clopidogrel 75mg (after appropriate loading - 600mg or 5 days of maintenance) recommended for 6/12 unless shorter duration (1-3/12) needed due to risk of life threatening bleeding
  • Consider clopidogrel for 3 months if high risk or 1 month if very high risk of bleeding
  • Prasugrel or ticagrelor can be considered in elective PCI if high risk features of procedure (underdeployment of stents, LMS, multivessel stenting) or if single agent needed due to aspirin intolerance
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12
Q

Antiothrombotic therapy in CCS and AF / Anticoagulation Indication

A
  • NOAC preferred to VKA
  • Recommended when CHADsVASc ≥2 in men, 3 in women, consider when ≥1 in men, 2 in women
  • Aspirin or clopidogrel can be added to NOAC if high risk of ischaemic events and do not have high bleeding risk

POST PCI
* Periprocedural DAPT (aspirin and clopidogrel) recommended for patients undergoing stent implantation
* If eligible for a NOAC, use NOAC in combination with anti-platelets over VKA
* Where high bleeding risk prevails over stent thrombosis risk and using rivaroxaban or dabigatran, reduce dose to be used (15mg OD, 110mg BD respectively)
* After uncomplicated PCI, early cessation of aspirin (1 week) should be considered, remaining on dual therapy with clopidogrel and NOAC if stent thrombosis risk is low or if bleeding risk prevails over thrombosis risk
* Triple therapy ≥1month but <6months should be considered where risk of stent thrombosis outweighs bleeding risk
* If VKA needed with along with aspirin or clopidogrel, INR range should be 2.0-2.5 with time in target 70%
* If moderate or high risk of stent thrombosis, NOAC with ticagrelor or prasugrel can be used as dual therapy
* AVOID ticagrelor or prasugrel as part of triple therapy

Use PPI in patients receiving aspirin, DAPT or triple therapy who are at high risk of GI bleeding

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13
Q

Second anti-thrombotic therapy choices in patients on aspirin who have moderate or high risk of ischaemic events and are not at high bleeding risk

A
  • Clopidogrel 75mg OD - for post MI patients who have tolerated DAPT for 1 year
  • Prasugrel 10mg or 5mg if body weight <60kg or age >75 - post PCI for patients who have tolerated DAPT for 1 year
  • Rivaroxaban 2.5mg BD - post MI >1 year or multivessel CAD
  • Ticagrelor 60mg BD - post MI who have tolerated DAPT for 1 year

Moderate Ischaemic Risk
* Diffuse multivessel CAD —> if this and 1 other RF –> High risk
* Diabetes requiring medication
* Recurrent MI
* PAD
* CKD (eGFR 15-59)

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14
Q

Lipid Management CCS

A
  • High risk of events if estblished CAD
  • LDL target <1.4 mmol/L (<55mg/dL)
  • Consider target <1.0mmol/L if second vascular event within 1 years on maximum tolerated statin therapy
  • Statins recommended in all patients
  • If target not reached, add ezetimibe
  • If target not reached on statin and ezetimibe, PCSK9 inhibitor recommended

Other Drugs
* ACE inhibitors (or ARBs) are recommended if HTN, heart failure (LVEF ≤40%) or diabetes
* Consider ACE inhibitors (or ARBs) if very high risk of events
* Beta-blockers recommended in HFrEF
* Consider beta-blockers in patients with previous STEMI

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15
Q

Descision Tree for Revascularisation in CCS

A
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16
Q

Follow up of patients with CCS

A
  • Sould be seen at least twice in first year post revascularisation or ACS
  • At least annually thereafter, irrespective of symptoms, with ECG every year
  • FBC, renal profile and lipids every 2 years
  • Consider echo every 3-5 years - if unexplained LV dysfunction, particularly if regional, coronary imaging
  • Consider asymptomatic stress testing every 3-5 years

Asymptomatic
* If asymptomatic but high risk by non-invasvive stratification and revascularisation would be considered for prognosis, consider coronary angiogram with FFR

Symptomatic
* Reassess CAD status if detiorating LV and no clear cause
* Risk stratify patients with new or worsening symptoms, ideally with stress imaging, or alternatively exercise stress ECG. Refer quickly
* Invasive angiogram recommended for patients with severe CAD, particularly if symptoms refractory to medical therapy or high risk profile

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17
Q

ANOCA recommendations

A
  • If angina with unobstructed coronary arteries, consider CFR/IMR guidewire assessment (IIa)
  • Acetylcholine testing can be considered to assess microvascular spasm
  • Consider non-invasive measurement of CFR with transthoracic doppler, MRI or PET
  • If CFR <2.0 or IMR ≥25 - abnormal microcirculatory function
  • If abnormal CFR or IMR and normal ACh testing - treatment: Betablockers, ACEi, statins, lifestyle changes, weight loss
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18
Q

Vasospastic Angina

A
  • Suspected if angina at rest, circadian pattern, more at night
  • Younger, fewer CV risk factors than obstructive CAD (except smoking)
  • Prinzmetal’s angina - specific subset with ST elevation
  • ECG during angina if possible. Consider ambulatory ECG
  • Invasive angiogram or CTCA recommended to investigate extent of underlying CAD in patients with characteristic chest pain and ECG changes at rest which resolve with nitrates or CCBs
  • Consider intracoronary provocation testing in patients with typical symptoms and unobstructed coronary arteries
  • Rx: Calcium Channel Blockers or long-acting nitrates.
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19
Q

CCS and HTN

A
  • BP target 120-130 systolic in most patients 130-140 in >65 year old
  • HTN and recent MI - BB and RAS blockers
  • HTN and angina - BB or CCBs
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20
Q

CCS and DM

A
  • Risk factor control to targets (LDL-c, HbA1c, BP) for patients with CAD and DM
  • In asytmptomatic DM + CAD patients, periodic resting ECG for conduction system abnormalities and arrhythmais and silent MI
  • ACEi recommended in DM +CAD
  • SGLT2i recommneded in DM +CAD
  • GLP-1 analogue (semaglutide, liraglutide) is recommended in DM +CAD
  • Consider functional imaging or CTCA for risk assessment in asmpytomatic patients with DM + CAD
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21
Q

Refractory Angina

A
  • EECP, CSR and spinal cord stimulation all class II
22
Q

Type of revascularisation in LMS and 3vD

A
23
Q

NSTE-ACS time to treatment

A
24
Q

NSTE-ACS anti-thrombotic therapy

A

Ticagrelor or prasugrel preferred to clopidogrel

If early angiography planned - pre-treatment is Aspirin only
Once angiography completed and proceeding with PCI - add Prasugrel
If angiogram completed and having medical therapy, ticagrelor preferred

25
Q

Stable CAD anti-thrombotic therapy

A
26
Q

Indications for revascularisation in stable CAD

A

For prognosis
* Left main stem disease with a stenosis >50% - 1a
* Proximal LAD disease with a stenosis >50% - 1a
* 2 or 3 vessel disease with a stenosis >50% and LVEF ≤35% 1a
* Large area of ischaemia detected by functional testing (≥10%) or abnormal invasive FFR - 1b
* Single remaining patent coronary artery with a stenosis >50% - 1c

For Symptoms
* Haemodynamically significant coronary stenosis in the presence of angina or angina equivalent symptoms with insufficient response to optimal medical therapy

27
Q

CABG or PCI in stable CAD with low surgical risk and anatomically suitable for both procedures

A
28
Q

Multivessel Disease or Left Main - Factors Favouring PCI

A

Clinical
* Significant comrbidity not reflected in STS score
* Advanced age / frailty / reduced life exectancy
* Restricted mobility or conditions that impact the rehabilitation process

Anatomical
* Multivessel disease with SYNTAX score 0-22
* Unlikely complete revascularisation with CABG due to poor quality or missing conduits
* Sequelae of chest radiation
* Severe chest deformation or scoliosis
* Porcelain aorta

29
Q

Multivessel Disease or Left Main - Factors Favouring CABG

A

Clinical
* Diabetes
* LVEF ≤35%
* Contra-indication to DAPT
* Recurrent or diffuse in-stent restenosis

Anatomical
* Multivessel disease with SYNTAX score ≥23
* Unlikely complete revascularisation with PCI
* Severe coronary calcification limiting stent expansion
* Ascending aortic pathology with indication for surgery or concurrent cardiac surgery needed

30
Q

Primary PCI for STEMI

A
  • Reperfusion therapy recommended for all patients with time from symptom onset < 12hours and ongoing ST elevation
  • In the absence of ST elevation, adopt a primary PCI strategy if ongoing ischaemic symptoms suggestive of myocardial infarction and at least one of:
  • Haemodynamic instability or cardiogenic shock
  • Recurrent or ongoing chest pain refractory to medical treatment
  • Lifethreatening arrhythmias or cardiac arrest
  • Mechanical complications of MI
  • Acute heart failure
  • Dynamic ST/T wave changes, particularly intermittent ST elevation
  • Primary PCI recommended over thrombolysis in the indicated time frames
  • If >12 hours since symptom onset, consider primary PCI if ongoing symptoms, signs of ischaemia, haemodynamic instability or arrhythmias
  • Consider primary PCI in patients presenting 12-48 hours after symptom onset
  • Consider no IRA PCI prior to discharge
  • Consider CABG with ongoing ischaemia and large areas of jeopardised myocardium if ppriamry PCI to IRA cannot be performed
  • Avoid non IRA PCI in patients with cardiogenic shock
  • Avoid routine thrombus aspiration
31
Q

Revascularisation in chronic heart failure (LVEF ≤35%)

A
  • In patients with severe LV systolic dysfunction and CAD suitable for intervention, revascularisation is recommended (1b)
  • CABG is revasculrisation option of choice in patients with multivessel disease and acceptable surgical risk (1b)
  • In 1 or 2 vessel disease, PCI can be considered as an alternative to CABG where complete revascularisation can be achieved (IIa)
  • In 3vD PCI can be considered as an alternative to CABG after Heart Team discussion, depending on coronary anatomy, completeness of revasc, diabetic status, and comorbidities (IIa)
  • Surgical aneurysmectomy can be considered during surgery if NHYA III/IV, large aneurysm, thrombus formation or aneurysm is souce of arrhythmias (IIa)
  • Surgical ventricular reconstruction during CABG can be considered in selected patients in centres with expertise (IIb)
32
Q

Revascularisation in cardiogenic shock

A
  • Emergency coronary angiography is recommended in patients with acute heart failure or cardiogenic shock complicating ACS
  • Emergency PCI of the culprit lesion is indicated in cardiogenic shock in the context of NSTE-ACS / STEMI, irrespective of the time of onset, if ammenable to PCI
  • Emergency CABG indicated for cardiogenic shock where coronary anatomy not suitable for PCI
  • If haemodynamic instability, catheter based repair of mechanical complications of MI are indicated as indicated by heart team
  • In selected patients with cardiogenic shock, short term use of mechanical ciculatory support may be indicated, taking account of comorbidities, neurological function, prospects for long term survival
  • Routine use of IABP not recommended
33
Q

Metformin and angiography

A
  • Theoretical risk of lactic acidosis - v small risk
  • Check renal function after angiography in patients on metformin
  • Generally recommended to stop metformin prior to elective cases - or check renal function after and stop if deteriorates
  • If renal impairment, stop metformin prior
34
Q

Concurrent coronary and valve intervention

A

Primary valve indication
* * If primary indication for aortic or mitral valve surgery and stenosis >70%, CABG indicated
* If primary indication for aortic or mitral valve surgery and stenosis 50-70%, CABG should be considered
* If primary indication for TAVI, PCI indicated if >70% stenosis in proximal segments
* If primary indication for transcatheter mitral intervention, PCI indicated if >70% stenosis in proximal segments

Primary coronary indication
* SAVR indicated for severe AS if undergoing CABG or other valve surgery
* Mitral surgery recommended along with CABG if severe secondary MR and LVEF >30%
* Consider Mitral surgery along with CABG if severe secondary MR and LVEF < 30% but myocardial viability and revasc option

35
Q

Carotid Disease in CABG patients

A
  • If need carotid and CABG intervention, MDT approach including neurologist

Recent TIA or stroke (< 6months)
* Duplex US scan recommended in patients undergoing CABG
* Consider carotid revascularisation if 50-99% stenosis, CEA first line, not indicated if < 50%

No recent TIA or stroke
* Consider duplex US if ≥70, multivessel coronary disease, concurrent lower limb arterial disease, carotid bruit
* If urgent CABG required and no recent TIA or stroke, routine duplex US not recommended
* Consider carotid revascularisation if bilateral 70-99% stenosis or unilateral 70-99% stenosis with opposite carotid occlusion
* Consider carotid revascularisation if 70-99% stenosis and 1 or more risk factor: contralateral TIA/stroke, ipsilateral silent infarction, intraplaque haemorrhage or lipid rich core on MRA, or high risk US findings (>20% progression, spontaneous embilisation on transcranial doppler, impaired cerebral vascular reserve, large plaques, echolucent plaques or increased juxtaluminal hypoechogenic area
* Routine revasc in patients with 70-99% stenosis not recommended

36
Q

Repeat Revascularisation

A

Early Post-operative Ischaemia and Graft Failure
* Coronary angiography is recommended post CABG for patients with:
- Symptoms of myocardial ischaemia and biomarkers suggestive of MI
- ECG changes suggesting large territory at risk
- New RWMA
- Haemodynamic instability

  • Decide on PCI or redo CABG based on ad hoc discusssion with Heart Team

Disease Progression and Late Graft Failure
* Repeat revascularisation is indicated in patients with a large area of ischaemia or symptoms despite medical therapy
* If considered safe, PCI should be considered first choice over CABG

Procedural Aspects of the Revascularisation - CABG
* IMA graft should be the graft of choice in redo CABG where IMA not previosly used
* Redo CABG should be considered in patients where no CABG was used

Procedural Aspects of the Revascularisation - PCI
* Distal protection devices should be considered for vein graft PCI
* PCI of the bypassed artery should be considered in preference to PCI of the vein graft where possible

Restenosis
* DEB and DES are both recommended (1a) for treatment of ISR of BMS or DES
* In patients with recurrent diffuse ISR, CABG should be considered over repeat PCI
* IVUS or OCT should be used to detect mechanical problems with stent leading to ISR

37
Q

Revascularisation - arrhythmia and sudden death

A
  • Patients with LVEF ≤35% being considered for ICD should be assessed for ischaemia and revascularisation targets
  • Urgent angiography (alongside antiarrhythmic drug therapy and ablation) should be used in patients with electrical storm
  • Early angiography is recommended in survivors of cardiac arrest, irrespective of the ECG findings, if no obvious non cardiac cause of arrest found
38
Q

Revascularisation - AF

A
  • Perioperative beta-blocker is recommended to reduce the incidence of AF
  • Restoration of sinus rhythm with DCCV or anti-arrhythmic drugs in post CABG AF, is recommended if haemodynamic instability
  • Consider perioperative amiodarone for AF prophylaxis in CABG
  • Consider long term anticoagulation according to stroke and bleeding risk in post CABG and post PCI AF
  • Initial managment of post operative AF - anticoagulation and rate control
  • Consider Antiarrhythmic drugs in symptomatic post CABG or PCI AF to restore sinus rhythm
  • May consider LAA occlusion or exclusion in patients with AF undergoing CABG
39
Q

CABG - procedural recommendations

A

General
* Complete revascularisation is recommended (all large vessles with stenosis ≥50%)
* Minimise aortic manipulation
* Consiider intraoperative graft flow measurements
* Consider pre-operative aortic CT in patients ≥70 or signs of gerneralised atherosclerosis
* Prior to aortic manipulations, consider epiaortic ultrasound to identify plaques

Conduit Selection
* Arterial grafting IMA to LAD is recommended
* Additional arterial grafting should be considered in appropriate patients
* Use of radial graft over vein graft is recommended in high grade stenosis (particularly if poor vein graft quality. Don’t use radial if previously catheterised)
* Bilateral IMA grafting recommended in patients who do not have a high risk of sternal wound infection (DM, obestiy, COPD, previous mediastinal radiation)

Vessel Harvesting
* Skeletonised IMA harvesting recommended in patients at risk of sternal wound infection
* Endoscopic vein harvesting or no touch open vein harvesting should be considered

Minimally invasive techniques
* Off pump and preferably no touch aortic techniques recommended in patients with signficant atherscloritic aortic disease. Also consider for selected high risk subgroups
* Consider minimally invasive LIMA-LAD in isolated LAD stenosis or in context of hybrid revasc
* Hybrid revasc may be considered in experienced centres in specific patient subsets

40
Q

PCI - procedural recommendations

A
  • DES over BMS in all settings
  • Radial preferred
  • IVUS and OCT recommended in selected patients to optimise stent expansion
  • IVUS recommended for unprotected LMS
  • PCI of bifurcations - provisional strategy (1a)
  • True LMS - consider DK crush (IIb)
  • Consider CTO PCI in patients with symptoms refractory to medical therapy or large area of documented ischaemia
41
Q

Antithrombotic therapy in PCI - Stable CAD, NSTE-ACS, STEMI

A
42
Q

Anti-thrombotic therapy in stable CAD PCI - recommendations

A
43
Q

Anti-thrombotic therapy in NSTE-ACS PCI - recommendations

A

Pre-treatment and antiplatelet therapy

    • Aspirin for all patients with 150-300mg loading and 75-100mg maintenaince long term
  • P2Y12 inhibitor recommended for 12 months. Praugrel (60mg loading, 10mg maintenance), ticagrelor (180mg loading, 90mg BD maintenance) and clopidogrel (600mg loading, 75mg maintenance) all recommended
  • As soon as diagnosis established, ticagrelor loading (or clopidogrel loading if not available) should be given as pre-treatment
  • GPIIb/IIIa antagonists can be given for bailout due to no reflow or thrombotic complications and considered during PCI for P2Y12 niave patients
  • Avoid pretreatment with GPIIb/IIIa inhibitors or prasugrel

Peri-interventional therapy
* Anticoagulation recommended for all patients
* Unfractionated heparin is recommended
* In patients on fondaparinux, single bolus of heparin 80 units / kg (or 60/kg if on GPIIb/IIIa)
* Enoxaparin should be considered in patients pre-treated with it
* Consider discontinuing anticoagulation immediately after invasive procedure
* Bivalirudin may be considered as an alternative up to 4hrs after procedure

Post interventional therapy
* 12 months treatment with P2Y12 for most patients unless excessive bleeding risk (PRECISE-DAPT score ≥25)
* If excessive bleeding risk, consider 6month P2Y12
* If treated with bioresorbable scaffold, give 12 months P2Y12
* Consider de-escalation of P2Y12 from ticagrelor or prasugrel to clopidogrel to cloidogrel as an alternative DAPT strategy for patients at high bleeding risk who can’t have 12 months on potent P2Y12 inhibitor
* Consider longer DAPT in patients who have tolerated it for 12 months without bleeding
* Consider ticagrelor 60mg BD for more than 12 months in patients with high ischaemic risk who have tolerated DAPT for 12 months
* Consider rivaroxaban 2.5mg BD in patients with no previous stroke or TIA with high ischameic risk and low bleeding risk, once parenteral anticoagulation stopped

44
Q

Anti-thrombotic therapy - STEMI

A

Same as NTE-ACS

45
Q

Anti-thrombotic therapy - CABG

A
  • Continue aspirin throughout
  • Before non-emergency CABG, stop ticagrelor for 3 days, clopidogrel for 5 days and prasugrel for 7 days
  • If PCI for ACS then CABG, restart P2Y12 as soon as safe then continue for 12 months as recommended
  • If high risk of bleeding (PRECISE-DAPT score ≥25) then consider stoping P2Y12 at 6 months
  • Can consider using platelet function to de-escalate in some patients.
  • If tolerate DAPT for 12 months without bleeding can consider longer duration in high ischaemic risk patients up to 36 months
46
Q

Anti-thrombotic therapy for PCI in patients with anti-coagulation indication

A
  • If VKA indication in combination with aspirin and/or clopidogrel, use lower end of INR target range

Factors increasing ischaemic risk:
* History of STEMI
* Treatment of CTO
* Treatment of bifurcation lesion with 2 stents implanted
* Total of 3 stents
* Total of ≥60mm of stent
* Diffuse coronary disease, particularly in DM
* CKD
* History of stent thrombosis on adequate antiplatelet therapy
* PCI to last remaining vessel

47
Q

Follow up after revascularisation

A
  • After CABG or PCI for AMI, cardiac rehabilitation, secondary prevention and lifestyle measures are recommended
  • Patients should be re-evaluated for symptoms and to reinforce secndary prevention at 3 months then annually

Symptomatic Patients
* Stress imaging should be considered in symptomatic patients with prior revascularisation
* Coronary angiography should is recommended in patients with intermediate to high risk findings on stress imaging

Asymptomatic Patients
* Consider stress testing at 6 months in high risk patients
* Consider angiography at 3-12 months in high risk PCI (i.e unprotected left main)
* Consider stress imaging at 1 year after PCI and 5 years after CABG

48
Q

NSTEMI - Antithrombotic Recommendations

A
49
Q

Atypical ECGs that should prompt primary PCI activation

A
50
Q

AF patients undergoing PCI for NSTEACS

A

Cardiology EECC (17 decks)

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