ACUTE CORONARY SYNDROME-MANAGEMENT (D. PCI)

SUMMARY

1. Percutaneous coronary intervention (PCI) is urgent reperfusion therapy using a stent (bare-metal or drug-eluting), superior to fibrinolytic therapy in STEMI (reduces mortality, recurrent MI & stroke), MI with new LBBB, posterior MI, acute HF.

2. BMS indications: high bleeding risk, inability to comply with 1 yr of dual antiplatelet therapy, anticipated invasive/surgical procedures in the next year.

3. Must be performed within 12 hrs of onset of symptoms and within 90 min of arrival to ED.

4. Patients who arrive beyond 12 hrs still require angiography if symptomatic, have decreased LVEF, in VT/VF or stress-test suggests ischaemia.

5. The dose and timing of adjuvant drug therapy is determined by the interventional cardiologist: DAPT & periprocedural anticoagulation with unfractionated heparin, enoxaparin or bivalirudin. A glycoprotein IIb/IIIa inhibitor may also be indicated.

6. If PCI cannot be delivered promptly, fibrinolytic therapy should be given within 30 min of the patient arriving at the hospital. In some healthcare services, paramedics can give fibrinolytic therapy before the patient reaches hospital.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].