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
What is 1 absolute CI that is specific to Streptokinase?
use within the previous 6 months
What is unique about Streptokinase’ Mechanism of action compared to the others
It is non fibrin specific
What is aPTT target with UFH use?
1.5-2.0x
How do you decide to give loading dose (300mg) Plavix in lysed patients?
Age: If age > 75 you do not give plavix load
What is UFH dosing in lysed patients?
-60 units/Kg IV bolus followed by 12 units/kg/hr infusion to maintain an aPTT 1.5-2x normal.
How to dose Enoxaparin in lysed STEMI if < 75y
-30mg bolus and then 1mg/kg q12h
Enoxaparin dose in lysed STEMI if age > 75y
-No bolus, 0.75mg/kg SC q12h
What to do with Enoxaparin dosing if CrCl < 30
q24h instead of q12h
What are 4 class 1 indications for PCI in patients who were initially lysed?
- Failed
- Shock/instability
- Spontaneous or easily provoked ischemia
- Intermediate or high risk findings on predischarge NIV testing
What is Plavix load in patients for PPCI? Lytic for PPCI?
- 600 mg
- 300mg
When should Plavix/Ticagrelor be held prior to CABG?
24 hours
Indications for MRA post STEMI?
EF < 40% with either symptomatic HF or DM
How long to wait after STEMI for VT to indicate ICD for secondary prevention
48 hours with no reversible etiology (ie recurrent arrhythmia)
5 risk factors for bleeding with treatment for ACS
- Age > 75
- Female
- Diabetes
- CrCl < 30
- Chronic use OAC
When to evaluate for ICD post MI?
40 days post discharge
