ACS/AMI III

Question 1

until how many days post MI do troponins remain elevated?

Answer 1

10d

Question 2

Sn of troops 6h after onset of CP?

Answer 2

65%

Question 3

which biomarker can quantitate the size of an infarct?

Answer 3

CK

Question 4

CK onset, peak, normalization

Answer 4

6-10h after MI onset
peaks at 1d
resolves in 2-3d

Question 5

causes of CKMB increase besides MI

Answer 5

CRF
GU/GI dz or Sx
marathons

Question 6

how long after sxs onset does CKMB2 reliably rise?

Answer 6

6h

Question 7

which trial made ASA in STEMI a Class I indication? (esp w/ A/C)

Answer 7

ISIS-2

Question 8

what did meta-analysis show for primary PCI vs/ thrombolysis in STEMI

Answer 8

decrease mortality with PCI

Question 9

if the STEMI sxs onset is <3h from arrival to ED, what is preferred strategy (PCI vs fibrinolysis)?

Answer 9

no preference unless contraindication or compelling indication (like Killip class III–> PCI)

Question 10

Absolute contraindications to fibrinolytic Rx

Answer 10

ICH
ischemic CVA within 3 mo's
significant facial/head trauma within 3 mo's
known brain lesion
suspected Ao dissection
active bleeding

Question 11

wich fibrinolytic agent has the relatively best 90 min latency and TIMI 3 flow rates?

Answer 11

TNK

Question 12

what are the only benefits of DES in STEMI?

Answer 12

less restenosis

less TVR at 1 yr

Question 13

which trial (by G. Stone) showed that Taxus DES had significantly less TLR c/t BMS?

Answer 13

HORIZONS-AMI

Question 14

which trial showed that there is no benefit to mortality with DES vs BMS?

Answer 14

HORIZONS-AMI

Question 15

does aspiration thrombectomy in STEMI improve survival?

Answer 15

yes

Question 16

which trial showed that there was no benefit to PCI of a totally occluded artery (c/w OMT)?

Answer 16

OAT

Question 17

should you routinely transfer STEMI patients for PCI after TNK fibrinolysis? Which trial addressed this?

Answer 17

Yes!

TRANSFER-AMI

Question 18

Name 3 subgroups that have atypical presentations or STEMI

Answer 18

women,elderly, diabetics

Question 19

In Keeley’s metanalysis, what was the on,y disadvantage of PCI over thrombolysis?

Answer 19

PCI had more major bleeding

Question 20

What do the new STEMI guidelines say about 90 mins?

Answer 20

It’s FIRST MEDICAL CONTACT to DEVICE TIME

Question 21

If pt with STEMI comes to non-PCI center, how long can the FCM-device time be including transfer?

Answer 21

120min

Question 22

What is an absolute contraindications specific to streptokinase?

Answer 22

Prior streptokinase in last 6 months

Question 23

Is recent, internal bleeding an absolute contraindications to fibrinolytic therapy in STEMI?

Answer 23

No, relative

Question 24

Which fibrinolytic agent has the most fibrin specificity?

Answer 24

TNK

Question 25

Which fibrinolytic agent has the least fibrin specificity?

Answer 25

Streptokinase