Thursday, July 14, 2016

Step 2 CK: Interventions that lower mortality in STEMI and ACS


For Step 2 CK, remembering things that lower mortality is essential. Here's a mnemonic for interventions that lower mortality in STEMI (ST elevation MI), NSTEMI (Non ST elevation MI) and UA (Unstable angina).

Percutaneous coronary intervention (PCI)
ACE inhibitors (ACEI)
Beta blockers (BB)

Here's some literature to go with the mnemonic :)

Aspirin:  Aspirin results in highly-significant reduction in vascular mortality in the acute therapy of patients with an ST elevation myocardial infarction (STEMI).

Percutaneous coronary intervention (PCI): If high-quality PCI is available, multiple randomized trials have shown enhanced survival and a lower rate of intracranial hemorrhage and recurrent MI compared to fibrinolysis.

Thrombolysis: Fibrinolytic therapy should be used in patients with symptom onset within 12 hours who cannot receive primary percutaneous coronary intervention within 120 minutes of first medical contact. The time interval from hospital arrival to initiation of fibrinolytic drug infusion should be less than 30 minutes. (In STEMI, not given in NSTEMI and UA)

ACE inhibitors: ACE inhibition produces favorable effects on mortality and LV function in selected high-risk post-AMI populations.

Beta blockers (BB): For patients with acute myocardial infarction (MI), beta blocker therapy reduces infarct size and early mortality when started early and lowers the risk of death when continued long term.

Statins: An intensive lipid-lowering statin regimen provides greater protection against death or major cardiovascular events than does a standard regimen. These findings indicate that such patients benefit from early and continued lowering of LDL cholesterol to levels substantially below current target levels.

We also give MON (Morphine, Oxygen, Nitroglycerin) but they are for symptomatic relief and have no proven mortality benefit.

That's all!

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