Percutaneous Coronary Intervention for Acute Coronary Syndromes Flashcards
What is the medical therapy recommended for STEMI patients?
Aspirin, beta-blockers, statins, and ACE inhibitors
Medical therapy is crucial for managing patients with STEMI.
What did the Occluded Arteries Trial (OAT) conclude about PCI in asymptomatic patients?
No benefit with PCI regarding death, reinfarction, or reduction in heart failure at 4-year follow-up
The trial involved over 2,000 patients with total occlusion of the infarct-related artery.
What is the recommended dose of enoxaparin for patients undergoing PCI?
0.3 mg/kg IV once
This is typically administered at the time of PCI for adequate anticoagulation.
What is a significant risk associated with fondaparinux during PCI?
Significant increase in catheter-related thrombosis
Fondaparinux is an indirect inhibitor of factor Xa with no effect on thrombin.
When is early angiography indicated in patients?
In patients with refractory angina or hemodynamic instability
The term ‘early’ generally means within 24 hours.
What is the recommended action for patients who received thrombolytic therapy 2 hours ago?
Admit to the coronary care unit for evaluation
Angiography should be considered within 3- to 24-hours after thrombolysis.
What are high-risk features that support an ‘early invasive’ strategy?
[“Recurrent angina/ischemia at rest”, “Elevated TnT or TnI”, “New ST-segment depression”, “Recurrent angina with symptoms”, “High-risk findings on stress testing”, “Depressed systolic function”, “Hemodynamic instability”, “Sustained ventricular tachycardia”, “Prior CABG”]
What is the Class III recommendation regarding PCI of a non-infarct-related artery?
Due to concerns over additional contrast use and higher complication rates
Recent trials have shown safety and efficacy for PCI of a non-infarct-related artery.
What are GP IIb/IIIa inhibitors primarily used for in ACS patients?
In patients considered for early invasive approach not adequately preloaded with a P2Y12 inhibitor
They provide rapid antiplatelet activity but are associated with increased bleeding risk.
What is the recommended treatment for a patient in cardiogenic shock with inferior STEMI?
Thrombolyze and transfer immediately
This approach is known as ‘drip and ship’ to a PCI-capable facility.
What procedure should be performed for a patient with a large thrombus burden?
Angioplasty and stent placement
This is to prevent distal embolization and poor cardiovascular outcomes.
What is the ideal strategy for antiplatelet therapy in patients undergoing PCI?
IV cangrelor loading followed by an infusion for 4 hours, transitioned to ticagrelor
Cangrelor provides immediate antiplatelet effects, suitable for patients inadequately loaded with P2Y12 inhibitors.
True or False: Patients undergoing PCI should receive a loading dose of P2Y12 inhibitors.
True
This is critical for achieving rapid platelet inhibition.
What is the outcome of the TAPAS trial regarding aspiration thrombectomy?
Significant improvement in myocardial blush grade with aspiration thrombectomy plus PCI
However, subsequent trials showed no benefit with routine thrombus aspiration.
What is a key benefit of clopidogrel in PCI?
Reduction in stent thrombosis
Cited from Bhatt DL, et al. N Engl J Med 2013;368(14):1303–1313.
When is cangrelor ideally suited for use?
For patients who couldn’t be adequately loaded with P2Y12 inhibitors before PCI and in whom GP inhibitors are not used.
What is a risk of administering clopidogrel hours after PCI?
Increased risk of stent thrombosis.
Why is it less desirable to use GP IIb/IIIa inhibitors with bivalirudin?
It negates the bleeding risk reduction provided by bivalirudin.
What is the recommendation for PCI of completely occluded vein grafts?
Class III recommendation against it due to low success rates and high risk for complications.
