SFGH 2.3 AM report pearls: Delayed STEMI presentation and PAD

  • There is no evidence that PCI or fibrinolytic therapy has any benefit for stable patients who present with a STEMI more than 12 hours after symptom onset
  • While having Guaiac positive stool is not an absolute contraindication to PCI, procedural bleeding risk factors include age >75, female, low body weight, anemia and CKD.
    • Most peri-procedural hemorrhage occurs at the access site (femoral>radial), with the retroperitoneum and GI tract as the next most common bleeding sites.
  • Risk of cholesterol emboli with an endovascular procedure directly correlates with the severity of atherosclerosis (very severe in this patient)
  • There are differing results when comparing UFH vs LMWH for STEMI patients who did not undergo reperfusion, and either is currently a reasonable choice.
    • The CREATE trial showed better outcomes for LMWH, while the TETAMI trial showed no significant difference in death, recurrent angina or reinfarction with UFH vs LMWH.
  • Antibiotics are recommended in suspected intestinal ischemia given the high risk for bacterial translocation from the compromised bowel wall. Other supportive measures include fluid resuscitation and improving hypoperfusion (though vasoconstricting pressors should be avoided)

o   The mortality associated with non-occlusive intestinal ischemia is 70-90%(!), primarily because of the severity of comorbid conditions in patients who develop this.

Evernote link: https://www.evernote.com/shard/s300/sh/5639ea67-8337-48ad-

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s