STEMI Flashcards
what is the meaning of TIMI 0 - 3 flow in angiogram?
TIMI 0 = no flow on angio
TIMI 1 = slight flow
TIMI 2 = slower than normal
TIMI 3 = normal/brisk
higher TIMI flow was associated with significantly better survival at 30 days
What is the max delay for PCI before you should give thrombolysis for a STEMI?
if you cannot be transferred and undergo PCI within 90 minutes, you should undergo thrombolysis within 30 minutes at the local facility.
what is the marker for response to thrombolysis?
we should see a resolution of the ST segments by 50% at 90 minutes.
if not, the patient should undergo urgent rescue PCI.
what are the blood thinning therapies we should be using in STEMI?
(what drugs are we also giving aside from reperfusion therapy)
aspirin - trial was called ISIS-2
clopidogrel - trial was called CLARITY-TIMI 28
prasugrel (a later metabolite than clopi - clopi requires 2 reactions to become active) was better than clopi - TRITON TIMI 38
ticagrelor (reversible inhibitor of the ADP-R on the platelet) - PLATO
Enoxaparin is better than UFH in STEMI patients (ExTRACT-TIMI25 trial)
Fondaparinux seems to be better for UAP, but still hasn’t really come into action in STEMI in Australia.
how long should a patient be on dual anti-platelet therapy for?
what is the name of the trial?
12 months
the trial was called “CURE” (and this was a NSTEMI trial, but has been extrapolated) and was from 2001
in what patient type is the data most robust for beta blocker following STEMI?
the CAPRICORN study looked at this.
the best evidence was for use of carvedilol in patients with EF < 40%
it improved both risk of re-MI, but also HF!
what about ACEi?
if you can tolerate, you should have
the study was extrapolated data from HOPE trial
what about statins? what target?
in someone who has had a STEMI, we would be targeting an LDL of = Scandinavian Simvastatin Survival Study
what is the post-infarct cocktail at present?
aspirin
2nd antiplatelet = clopi, prasugrel or ticagrelor
lipid lowering agent (statin)
ACEi
beta blocker (particularly if LV dysfunction)
