What is the preferred cardiac biomarker for ACS?
The cardiac troponins, in particular, have become the cardiac markers of choice for patients with ACS, eclipsing CK-MB and myoglobin in terms of clinical value.
What is the goal for PCI when treating a STEMI?
In the setting of acute ST-elevation myocardial infarction (STEMI), the primary goal of percutaneous coronary intervention (PCI) or fibrinolysis is to reestablish patency of the affected coronary artery and thereby improve perfusion of the myocardium.
When is PCI not indicated?
Clinical contraindications for PCI include intolerance of long-term antiplatelet therapy or the presence of any significant comorbid conditions that severely limit the lifespan of the patient (this is a relative contraindication).
When is PCI needed after thrombolysis?
The timing of PCI after thrombolysis can be classified as immediate (as soon as possible after thrombolysis), early (within 24 hours after thrombolysis), rescue (performed only for failed thrombolysis) or deferred (more than 24 hours after thrombolysis).
How soon should PTCA be performed?
The recommendation states that PTCA can be an alternative “in patients who are within 36 hours of an acute ST-elevation/Q-wave or new left bundle branch block infarction who develop cardiogenic shock, are less than 75 years of age and in whom revascularization can be performed within 18 hours of shock.”
What is the standard of MI?
The gold standard for diagnosing myocardial infarction has been the World Health Organization definition, which requires any 2 of 3 criteria: ischemic symptoms, electrocardiographic changes, and elevated creatine kinase-MB levels.
When should PCI be used in STEMI patients?
STEMI patients at substantial (greater than or equal to 4%) risk of ICH should be treated with PCI rather than with fibrinolytic therapy. (See Figure 3 for further management considerations.) (Level of Evidence: A) A detailed list of contraindications and cautions for the use of fibrinolytic therapy is shown in Table 2.
What are the follow-up ECG guidelines for STEMI (STEMI)?
Electrocardiographic Techniques All patients with STEMI should have follow-up ECGs at 24 hours and at hospital discharge to assess the success of reperfusion and/or the extent of infarction, defined in part by the presence or absence of new Q waves. (Level of Evidence: B) 2. Cardiac Biomarker Methods
How should providers manage CABG patients after STEMI?
Providers should individualize patient management on the basis of clinical circumstances, available revascularization options, and patient preference. 5. CABG Surgery After STEMI and Antiplatelet Agents 1. Aspirin should not be withheld before elective or nonelective CABG after STEMI. (Level of Evidence: C) 2.
What are the ACCF/AHA guidelines for the use of anticoagulants in STEMI?
Current ACCF/AHA guidelines provide a Class I indication for the use of an anticoagulant as soon as the diagnosis of STEMI is made. (1) Parenteral anticoagulants include indirect thrombin inhibitors, such as unfractionated heparin (UFH) and enoxaparin, and direct thrombin inhibitors, such as bivalirudin.
