AHA Revascularization Guidelines Flashcards
(24 cards)
What needs to be calculated for patient considering CABG?
STS Score
What are three risk factors not quantified in STS score but should be?
Cirrhosis- MELD
Frailty- Gait Speed
Malnutrition- MUST (Malnutrition Universal Screening Tool)
What are 3 Class 1 indications for PCI in STEMI?
- STEMI with < 12h and ischemic symptoms
- HD instability regardless of time
- Failed reperfusion
What are 2 class 2a indications for PCI in STEMI?
- STEMI lysed within 3-24h
- Stable STEMI 12-24 hours
What two scenarios should CABG not be done in failed PCI for STEMI?
- No feasible due to a no-flow state or poor distal targets
- In the absence of ischemia or a large area of myocardium at risk
What is Class 1 indication for non culprit PCI in STEMI? Class III?
- Class 1: Stable patients, staged PCI of significant non-infarct artery
- Class 3: Unstable patient
What 3 class 1 indications for Early invasive strategy in NSTEACS?
- High risk by GRACE (> 140) or TIMI (>2)
- Unstable
- Refractory Chest pain
What are 2 class 1 indications for revascularization in SIHD to improve survival?
- Multivessel CAD with LVEF < 35% (CABG)
- LMCA (CABG)
What is the only Class 1 indication for revascularization in SIHD for symptoms?
Refractory angina on medical therapy
How long should CABG be delayed in renal patients post Cath?
> 24 hours
4 measures to reduce risk of CIN?
- Assess risk of CIN before procedure
- Administer adequate preprocedural hydration
- Minimize contrast
- USe radial artery if feasible
What ate 3 benefits of Radial approach compared to femoral?
- Less bleeding
- Less arterial injury
- Lower mortality
What anticoagulant should be used in treating ACS?
-UFH
What kind of graft is preferred when grafting the second most important artery?
-Radial (As opposed to saphenous)
What are 5 measures to reduced sternal wound infection in CABG?
- Staph testing with nasal swab
- Apply 2% mupirocin ointment to known nasal carriers of S. Aureus
- Measuer perioperative Hbac1
- Smoking cessation
- Apply vancomycin to the cut edges of the stenrum on opening
- Treat all extrathoracic infections before non emergency surgical coronary revascularization
When to start aspirin post CABG?
6 hours post (325mg)
Name 1 class 3 indication for revascularization in STEMI
STEMI > 24 hours with no ischemic symptoms
3 populations with NSTEACS to proceed with Emergency Revascularization?
- HD Unstable/Cardiogenic Shock
- Electrical Instability
- Refractory Chest Pain
What population to perform early invasive strategy (< 24h) as opposed to emergent/Immediate?
High risk of Ischemic events but stable (GRACE > 140)
3 beneficial outcomes in those with early invasive strategy in high risk?
- Less recurrent ischemic event
- Less need for urgent revascularization
- Less hospital stay
3 class 1 indications for CABG in SIHD?
- LVEF < 35% and multivessel CAD
- Symptomatic LMCA
- Multivessel CAD with DM
What to do with LVEF 35-50% and multivessel SIHD?
CABG (Class 2a)
What should patients get for 1 year post CABG with Radial Artery use?
CCB for 1 year
3 non pharm interventions post revasc?
- Stress reduction
- Cardiac Rehab
- Smoking Cessation
