Management of Acute Coronary Syndromes

Question 1

What did the AVOID study show?

Answer 1

patients who had supplemental oxygen in ACS had worse outcomes

Question 2

What is the risk of ICH in thrombolysis?

Answer 2

approx 1%

Question 3

Should balloon pump be used routinely for cardiogenic shock and STEMI?

Answer 3

no - as per SHOCK II trial

Question 4

Should thrombus aspiration be used in STEMI routinely?

Answer 4

no

Question 5

Should thrombolysis be followed by PCI routinely?

Answer 5

yes - within 3-24 hours

Question 6

What did the STREAM study show?

Answer 6

for STEMI in regional settings no difference between thrombolysis followed by PCI within 24 hours vs transfer for PCI alone within 2 hours

Question 7

What is the aim for door to balloon time for primary PCI?

Answer 7

<60 minutes

Question 8

What score should be used for risk stratification for suspected ACS?

Answer 8

GRACE score

Question 9

What did the ATLAS ACS-2 trial show?

Answer 9

giving rivaroxaban post ACS had a reduction in death/MI/stroke but 3 x increase in major bleeding so not commonly used

Question 10

How long should DAPT be given post PCI for ACS?

Answer 10

usual recommendation is for 12/12 however many studies have shown can give 3-6/12

Question 11

Is there any indication to give DAPT for longer than 12/12?

Answer 11

Yes - if high risk and low bleeding risk - evidence of benefit in a trial