Primary, Rescue, and Facilitated Angioplasty Flashcards
What is the recommended door-to-balloon time for PCI in acute STEMI according to the 2013 ACC/AHA guidelines?
90 minutes
An additional 30 minutes is allowed if the patient is transferred from a non–PCI-capable facility.
What is considered a contraindication for elective PCI during primary PCI of the infarct-related artery?
Performing elective PCI in a non–infarct-related artery in patients without hemodynamic compromise
This is outlined in the 2013 ACC/AHA guidelines.
What is the Class I recommendation regarding therapeutic hypothermia in patients with out-of-hospital cardiac arrest?
Initiation of therapeutic hypothermia should occur in patients with VT or VF and emergent primary PCI
PCI should not be delayed for hypothermia initiation.
In asymptomatic patients who are hemodynamically stable more than 12 hours after STEMI onset, what does the 2013 guidelines recommend?
They should be admitted for management of MI and referred for semi-elective cardiac catheterization.
What is the ideal timing for administering a P2Y12 inhibitor in patients with acute STEMI?
As early as possible during primary PCI.
What loading dose of ticagrelor is recommended for patients with acute STEMI?
180 mg loading dose followed by 90 mg twice daily.
What are the outcomes of primary PCI compared to fibrinolytic therapy based on 12 randomized clinical trials?
Lower mortality rates, fewer reinfarctions, and fewer hemorrhagic strokes
Mortality rates: 5.9% vs. 7.7%, reinfarctions: 1.6% vs. 5.1%.
True or False: Embolic protection devices have shown benefit in primary PCI for STEMI.
False
Trials such as EMERALD and PROMISE did not demonstrate a benefit.
What is the recommended dose of unfractionated heparin (UFH) for achieving therapeutic activated clotting time (ACT)?
70 to 100 units/kg.
If a patient with STEMI is at a non–PCI-capable facility, what is the maximum door-in-door-out time recommended?
30 minutes.
What is the clinical significance of an occluded LCx artery in a patient presenting with chest pain?
It can indicate a (relatively) electrocardiographically silent lateral MI.
What does the Occluded Artery Trial suggest about late PCI days after MI in stable patients?
No benefit and a trend toward harm.
What was the conclusion of the FINESSE trial regarding facilitated pharmacologic strategies for reperfusion?
They did not improve clinical outcomes compared to primary PCI with abciximab.
What does the 2013 STEMI/PCI Guidelines emphasize regarding regional systems of STEMI care?
Encouraging collaboration among stakeholders to evaluate care and measure outcomes.
Fill in the blank: Primary PCI with stenting shows lower mortality rates compared to _______.
fibrinolytic therapy.
What is the recommended action for patients with acute graft failure after CABG?
Consider revascularization with emergency PCI if feasible.
What is the recommended treatment for patients with STEMI who weigh less than 60 kg or are 75 years or older?
Prasugrel is generally not recommended.
What is the primary focus of the AHA’s ‘MissionLifeline’ initiative?
To encourage cooperation between prehospital emergency services and cardiac care professionals.
What is the importance of regional systems of STEMI care?
Encourages participation of key stakeholders in collaborative efforts to evaluate care, measuring outcomes and adherence to evidence-based processes.
What is the recommended initial dose of clopidogrel for patients ≤75 years of age receiving fibrinolytic therapy?
300 mg
What is the recommended dose of clopidogrel for patients >75 years of age receiving fibrinolytic therapy?
75 mg
What is a reasonable approach for high-risk patients receiving fibrinolytic therapy?
Early PCI with an appropriate antithrombotic regimen.
What did the HORIZONS-AMI trial compare?
Bivalirudin vs. heparin plus a GP IIb/IIIa inhibitor in patients presenting with STEMI.
What was the primary outcome of the RIFLE-STEACS Trial?
Composite death/MI/stroke/target vessel revascularization (TVR)/non-CABG bleeding.
What anticoagulant therapies can be used with fibrinolytic therapy?
UFH, enoxaparin, fondaparinux.
What is the initial dose of UFH for patients receiving fibrinolytic therapy?
60 U/kg bolus (max 4,000 U) followed by an infusion of 12 U/kg/h (max 1,000 U).
What is an absolute contraindication to fibrinolytic therapy?
Ischemic stroke within 3 months.
What recommendation do the 2013 ACC/AHA guidelines provide for delayed PCI in asymptomatic patients?
Class III (no benefit) recommendation.
