STEMI (CCS 2019 + AHA 2013) Flashcards
What is cut off in time in peripheral hospital for deciding to lyse or ship for PCI?
120 minutes
What is FMC-STEMI diagnosis target?
< 10 minutes
What is PPCI time interval goal?
FMC to PPCI < 90 minutes
What is transfer time for PPCI goal?
< 60 minutes
What is FMC to needle time target?
< 30 minutes
When can PCP crews be used instead of ACP?
When patients is stable or when ACP crew not readily available
What is time interval from diagnosis to cath lab activation?
10 minutes
What is door in door out time for STEMI in ER
30 minutes
What is time from arrival at cath lab to first device deployment?
30 minutes
Time from lytic to cath?
< 24 hours
What is SPO2 goal in STEMI?
> 90 %
Is pre-hospital P2Y12 inhibitor recommended?
No, but should be administered as soon as possible in ED
What is recommended anticoagulation in STEMI?
UFH
What is recommended AC in patients with history of HIT?
Bivalirudin
2 Class 1 indications for pPCI in STEMI and 1 class IIa
- Ischemic symptoms < 12 hours
- Shock at any time
- Ongoing ischemia 12-24 hours
When to use BMS? (AHA 2013)
When patients can’t tolerate DAPT for 1 year, high bleeding risk.
What is UFH dose without GP IIb/IIIa ?
70-100 U/kg IV bolus
What is Bivalirudin dosing in STEMI?
0.75 mg/kg IV bolus then 1.75 mg/kg/h
Reduce infusion to 1 mg/kg/hr if CrCl < 30
What AC shouldn’t be used for STEMI?
Fondaparinux
What is TNK dosing?
- 30mg for < 60kg, 35mg for < 70kg etc
0. 5mg/kg
What is TPA dosing?
0.75 mg/kg for 30 mins and 0.5 mg/kg over next 60 minutes (90 minutes total)
What is dosing of Streptokinase?
1.5 million units over 30-60 minutes
What is patency rate (Timi 2 or 3) for TNK?
85%
What are 9 absolute CIs for lytic?
- Prior ICH
- Known structural cerebral vascular disease (AVM)
- Malignant IC neoplasm
- Ischemic stroke < 3 months
- Aortic Dissection
- Active bleeding or bleeding diathesis
- Significant closed-head or facial trauma < 3 months
- Intracranial or spinal surgery < 2 months
- Severe uncontrolled hypertension
