AHA Revascularization Guidelines

Question 1

What needs to be calculated for patient considering CABG?

Answer 1

STS Score

Question 2

What are three risk factors not quantified in STS score but should be?

Answer 2

Cirrhosis- MELD

Frailty- Gait Speed

Malnutrition- MUST (Malnutrition Universal Screening Tool)

Question 3

What are 3 Class 1 indications for PCI in STEMI?

Answer 3

• STEMI with < 12h and ischemic symptoms
• HD instability regardless of time
• Failed reperfusion

Question 4

What are 2 class 2a indications for PCI in STEMI?

Answer 4

• STEMI lysed within 3-24h

- Stable STEMI 12-24 hours

Question 5

What two scenarios should CABG not be done in failed PCI for STEMI?

Answer 5

• 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

Question 6

What is Class 1 indication for non culprit PCI in STEMI? Class III?

Answer 6

• Class 1: Stable patients, staged PCI of significant non-infarct artery
• Class 3: Unstable patient

Question 7

What 3 class 1 indications for Early invasive strategy in NSTEACS?

Answer 7

• High risk by GRACE (> 140) or TIMI (>2)
• Unstable
• Refractory Chest pain

Question 8

What are 2 class 1 indications for revascularization in SIHD to improve survival?

Answer 8

• Multivessel CAD with LVEF < 35% (CABG)

- LMCA (CABG)

Question 9

What is the only Class 1 indication for revascularization in SIHD for symptoms?

Answer 9

Refractory angina on medical therapy

Question 10

How long should CABG be delayed in renal patients post Cath?

Answer 10

> 24 hours

Question 11

4 measures to reduce risk of CIN?

Answer 11

• Assess risk of CIN before procedure
• Administer adequate preprocedural hydration
• Minimize contrast
• USe radial artery if feasible

Question 12

What ate 3 benefits of Radial approach compared to femoral?

Answer 12

• Less bleeding
• Less arterial injury
• Lower mortality

Question 13

What anticoagulant should be used in treating ACS?

Answer 13

-UFH

Question 14

What kind of graft is preferred when grafting the second most important artery?

Answer 14

-Radial (As opposed to saphenous)

Question 15

What are 5 measures to reduced sternal wound infection in CABG?

Answer 15

• 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

Question 16

When to start aspirin post CABG?

Answer 16

6 hours post (325mg)

Question 17

Name 1 class 3 indication for revascularization in STEMI

Answer 17

STEMI > 24 hours with no ischemic symptoms

Question 18

3 populations with NSTEACS to proceed with Emergency Revascularization?

Answer 18

• HD Unstable/Cardiogenic Shock
• Electrical Instability
• Refractory Chest Pain

Question 19

What population to perform early invasive strategy (< 24h) as opposed to emergent/Immediate?

Answer 19

High risk of Ischemic events but stable (GRACE > 140)

Question 20

3 beneficial outcomes in those with early invasive strategy in high risk?

Answer 20

• Less recurrent ischemic event
• Less need for urgent revascularization
• Less hospital stay

Question 21

3 class 1 indications for CABG in SIHD?

Answer 21

• LVEF < 35% and multivessel CAD
• Symptomatic LMCA
• Multivessel CAD with DM

Question 22

What to do with LVEF 35-50% and multivessel SIHD?

Answer 22

CABG (Class 2a)

Question 23

What should patients get for 1 year post CABG with Radial Artery use?

Answer 23

CCB for 1 year

Question 24

3 non pharm interventions post revasc?

Answer 24

• Stress reduction
• Cardiac Rehab
• Smoking Cessation