ESC ACS 2023

Question 1

Fibrinolysis combined with rescue PCI (in cases of failed fibrinolysis) or routine early PCI strategy (in cases of successful fibrinolysis)

Answer 1

Pharmaco-invasive strategy

Question 2

ACS Spectrum

Answer 2

Question 3

Classification of patients suspected of ACS

Answer 3

Question 4

In patients with a working diagnosis of STEMI, a _______ strategy (i.e. immediate angiography and PCI as needed) is the preferred reperfusion strategy

Answer 4

PPCI

Question 5

For patients who undergo fibrinolysis, _____________ is indicated if fibrinolysis fails (i.e. ST-segment resolution <50% within 60–90 min of fibrinolytic administration) or in the presence of haemodynamic or electrical instability, worsening ischaemia, or persistent chest pain.

Answer 5

Rescue PCI

Question 6

Patients with successful fibrinolysis should undergo early invasive angiography (i.e. within ________ from the time of the lytic bolus injection)

Answer 6

2–24 h

Question 7

Modes of presentation and pathways to invasive management and myocardial revascularization in patients presenting with STEMI

Goals:
Ischemic time
Door to wiring
Door to needle

Answer 7

<120mins
<90mins
<10mins

Question 8

Criteria for VHR NSTEMI

Answer 8

Haemodynamic instability or cardiogenic shock
Recurrent or ongoing chest pain refractory to medical treatment
Acute heart failure presumed secondary to ongoing myocardial ischaemia
Life-threatening arrhythmias or cardiac arrest after presentation
Mechanical complications
Recurrent dynamic ECG changes suggestive of ischaemia

Question 9

Rescue PCI for failed fibrinolysis is Class ______ recommendation

Answer 9

Class I

Question 10

Give dosing of Tirofiban

Answer 10

Bolus of 25 mcg/kg i.v. over 3 min, followed by an infusion of 0.15 mcg/kg/min for up to 18 h.

Question 11

In p tients with a working diagnosis of NSTE-ACS, routine pre-treatment with a __________________ before knowing the coronary anatomy in patients anticipated to undergo an early invasive strategy (i.e. <24 h) is not recommended.

Answer 11

P2Y 12 receptor inhibitor

Question 12

Alternative antiplatelet strategies to reduce bleeding risk in the first 12 months after an ACS.

Answer 12

Question 13

____________. is recommended irrespective of the treatment strategy (invasive or conservative)

Answer 13

Ticagrelor (180 mg LD, 90 mg b.i.d. MD)

Question 14

As the default strategy for patients with atrial fibrillation and CHA2 DS2 -VASc score ≥1 in men and ≥2 in women, after up to __________ of triple antithrombotic therapy following the ACS event, dual antithrombotic therapy using a NOAC at the recommended dose for stroke prevention and a single oral antiplatelet agent (preferably clopidogrel) for up to 12 months is recommended.

Answer 14

1 week

Question 15

In patients who are event-free after __________ of DAPT and who are not high ischaemic risk, single antiplatelet therapy (preferably with a P2Y12 receptor inhibitor)

Answer 15

3–6 months

Question 16

Antiplatelet therapy with fibrinolysis

Answer 16

ASA and Clopidogrel

Question 17

True or False

Routine immediate angiography after resuscitated cardiac arrest is not recommended in haemodynamically stable patients without persistent ST-segment elevation

Question 18

Immediate coronary angiography and PCI of the ______________ is recommended in patients with CS complicating ACS.3

Answer 18

IRA (if indicated)

Question 19

_______________ should be considered in STEMI patients presenting with CS if a PPCI strategy is not available within 120 min from the time of STEMI diagnosis and mechanical complications have been ruled out

Answer 19

Fibrinolysis

Question 20

Recommendations in Cshock

Answer 20

Question 21

Answer 21

Question 22

Answer 22

Question 23

Intravascular imaging (preferably __________) in patients with ambiguous culprit lesions (Class llb)

Answer 23

OCT

Question 24

Complete revascularization, either during the index procedure or within _________ (Class I)

Answer 24

45 days

Question 25

Refers to the clinical situation when a patient presents with symptoms suggestive of ACS, demonstrates troponin elevation, and has non-obstructive coronary arteries at the time of coronary angiography (defined as coronary artery stenosis <50% in any major epicardial vessel).

Answer 25

Myocardial infarction with non-obstructive coronary arteries (MINOCA)

Question 26

____________ should be considered in patients with equivocal echocardiographic images or in cases of high clinical suspicion of LV thrombus

Answer 26

CMR imaging

Question 27

Oral anticoagulant therapy (_____________) should be considered for 3–6 months in patients with confirmed LV thrombus.

Answer 27

VKA or NOAC

Question 28

ICD therapy is recommended to reduce sudden cardiac death in patients with symptomatic HF (NYHA Class II–III) and LVEF ≤35% despite optimal medical therapy for __________ and at least 6 weeks after MI who are expected to survive for at least 1 year with good functional status.4

Answer 28

>3 months

Question 29

Long-term management after acute coronary syndrome.

Answer 29

Question 30

It is recommended that ____________ therapy is initiated or continued as early as possible, regardless of initial LDL-C values.

Answer 30

High-dose statin

Question 31

In patients with pre-discharge LVEF ≤40%, repeat evaluation of the LVEF _________ after an ACS

Answer 31

6–12 weeks