ACS management

Question 1

When to perform CTA and PCI in STEMI

Answer 1

• Offer if presenting in 12 hours of symptoms and PCI can be delivered in 120 mins
• Consider if presenting more than 12 hours after symptoms and continuing MI or cardiogenic shock

Question 2

What is the first steps in managing a patient with suspected STEMI?

Answer 2

1. Aspirin 300mg
2. Immediately assess eligibility for coronary reperfusion therapy (primary PCI or fibrinolysis) regardless of age, ethnicity, sex, or consciousness level.

Question 3

What vascular access site is preferred for PCI according to NICE?

Answer 3

Radial artery access is preferred over femoral access to reduce bleeding complications.

Question 4

What is the recommended antiplatelet therapy for patients undergoing primary PCI?

Answer 4

Aspirin plus prasugrel (unless the patient is already on oral anticoagulants, then clopidogrel is preferred).

Question 5

What therapy should be given alongside fibrinolysis?

Answer 5

An antithrombin (e.g., low molecular weight heparin) should be administered at the same time as fibrinolysis.

Question 6

Secondary prevention therapy

Answer 6

ACE-i
Dual Anti-PLT for 12 months
Beta-blocker
Statin high dose

Question 7

When should coronary angiography/PCI be offered in NSTEMI or unstable angina?

Answer 7

• Within 72 hours of admission
• GRACE score > 3%
• or sooner if unstable.

Question 8

What lifestyle advice should be given to patients with ACS?

Answer 8

Smoking cessation, diet modification, physical activity, weight management, and control of comorbidities.

Question 9

What role does cardiac rehabilitation play after NSTEMI or unstable angina?

Answer 9

It improves survival, quality of life, and reduces recurrent events; should be offered to all suitable patients.

Question 10

How is risk stratification performed in NSTEMI and unstable angina?

Answer 10

Use a validated risk score such as the GRACE score to estimate 6-month mortality and guide management.