Podcast
Questions and Answers
Which organization collaborated with the ACC and AHA in developing the acute coronary syndrome guidelines?
Which organization collaborated with the ACC and AHA in developing the acute coronary syndrome guidelines?
- American Medical Association
- Centers for Disease Control and Prevention
- World Health Organization
- National Association of EMS Physicians (correct)
According to the guideline, all members of the writing committee were required to abstain from voting on sections to which their industry relationships might apply.
According to the guideline, all members of the writing committee were required to abstain from voting on sections to which their industry relationships might apply.
True (A)
Which of the following is NOT explicitly listed as a key word within the guideline?
Which of the following is NOT explicitly listed as a key word within the guideline?
- Time factors
- Hyperlipidemia (correct)
- Atrial fibrillation
- Treatment outcome
Dual antiplatelet therapy with aspirin and a ______ inhibitor is indicated for at least 12 months as the default strategy in patients with ACS who are not at high bleeding risk.
Dual antiplatelet therapy with aspirin and a ______ inhibitor is indicated for at least 12 months as the default strategy in patients with ACS who are not at high bleeding risk.
Match the following antiplatelet medications with their recommended use in ACS patients:
Match the following antiplatelet medications with their recommended use in ACS patients:
According to the guideline, when should serial ECGs be performed in patients with suspected ACS but an initial nondiagnostic ECG?
According to the guideline, when should serial ECGs be performed in patients with suspected ACS but an initial nondiagnostic ECG?
Red blood cell transfusion to maintain a hemoglobin level of 10 g/dL is recommended in all patients with ACS and acute or chronic anemia.
Red blood cell transfusion to maintain a hemoglobin level of 10 g/dL is recommended in all patients with ACS and acute or chronic anemia.
In resuscitated patients who are comatose after cardiac arrest and have STEMI, what approach merits careful individual assessment according to the guidelines?
In resuscitated patients who are comatose after cardiac arrest and have STEMI, what approach merits careful individual assessment according to the guidelines?
According to the guideline, In patients with non-ST-segment elevation ACS who show intermediate or high-risk traits for recurring ischemic events, an invasive approach aimed at ______ is advised during hospitalization.
According to the guideline, In patients with non-ST-segment elevation ACS who show intermediate or high-risk traits for recurring ischemic events, an invasive approach aimed at ______ is advised during hospitalization.
Match each characteristic with whether it is more representative of NSTEMI or STEMI:
Match each characteristic with whether it is more representative of NSTEMI or STEMI:
According to the guideline, approximately what percentage of ACS patients are estimated to have an out-of-hospital cardiac arrest?
According to the guideline, approximately what percentage of ACS patients are estimated to have an out-of-hospital cardiac arrest?
For STEMI patients who are transferred to a PCI-capable center, direct transport to a PCI-capable hospital is always preferred, regardless of the anticipated FMC-to-device time.
For STEMI patients who are transferred to a PCI-capable center, direct transport to a PCI-capable hospital is always preferred, regardless of the anticipated FMC-to-device time.
According to the guideline, for patients with ACS, in whom PCI is not available and a rapid treatment is important, treatment with ______ becomes necessary.
According to the guideline, for patients with ACS, in whom PCI is not available and a rapid treatment is important, treatment with ______ becomes necessary.
Match the description with its corresponding term in the context of classification for acute myocardial infarction:
Match the description with its corresponding term in the context of classification for acute myocardial infarction:
According to the guideline, what is the recommended target oxygen saturation for patients with ACS?
According to the guideline, what is the recommended target oxygen saturation for patients with ACS?
According to the guidelines, opiate usage is primarily suggested for relief of symptoms resistant to other maximally tolerated anti-ischemic medications.
According to the guidelines, opiate usage is primarily suggested for relief of symptoms resistant to other maximally tolerated anti-ischemic medications.
If a patient is receiving ticagrelor as a P2Y12 inhibitor for ACS but required to undergo bypass surgery, then their clinical management should be adjusted to interrupt medication for ______ before surgery
If a patient is receiving ticagrelor as a P2Y12 inhibitor for ACS but required to undergo bypass surgery, then their clinical management should be adjusted to interrupt medication for ______ before surgery
Match recommendations pertaining to routine catheter usage for CAD:
Match recommendations pertaining to routine catheter usage for CAD:
According to the guidelines, what is a recommended action in assessing if antiplatelet agents may be helpful to improving some outcomes?
According to the guidelines, what is a recommended action in assessing if antiplatelet agents may be helpful to improving some outcomes?
After PCI following STEMI, it is recommended for patients to follow complete revascularization
After PCI following STEMI, it is recommended for patients to follow complete revascularization
The recommendations listed in ACS guideline are made per the evidence available; extensive review included human subject research indexed by key databases like []
The recommendations listed in ACS guideline are made per the evidence available; extensive review included human subject research indexed by key databases like []
Match given classes during clinical testing:
Match given classes during clinical testing:
Flashcards
Aim of the 2025 ACS Guideline?
Aim of the 2025 ACS Guideline?
Incorporates new evidence for managing acute coronary syndromes.
Initial antiplatelet therapy for ACS
Initial antiplatelet therapy for ACS
Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor.
Which P2Y12 inhibitors are recommended?
Which P2Y12 inhibitors are recommended?
For ACS patients undergoing PCI.
What to use if other P2Y12 inhibitors are unavailable?
What to use if other P2Y12 inhibitors are unavailable?
Signup and view all the flashcards
How long should DAPT be prescribed
How long should DAPT be prescribed
Signup and view all the flashcards
Recommended lipid-lowering therapy in ACS
Recommended lipid-lowering therapy in ACS
Signup and view all the flashcards
Recommended management for intermediate/high-risk NSTE-ACS?
Recommended management for intermediate/high-risk NSTE-ACS?
Signup and view all the flashcards
Preferred PCI access approach in ACS?
Preferred PCI access approach in ACS?
Signup and view all the flashcards
Recommended technique to guide PCI in ACS?
Recommended technique to guide PCI in ACS?
Signup and view all the flashcards
Transfusion threshold in ACS patients
Transfusion threshold in ACS patients
Signup and view all the flashcards
Initial Goals In suspected ACS approach
Initial Goals In suspected ACS approach
Signup and view all the flashcards
Oxygen saturation goals in ACS
Oxygen saturation goals in ACS
Signup and view all the flashcards
ECG to acquired in 10 minutes?
ECG to acquired in 10 minutes?
Signup and view all the flashcards
ECG is a guide to use
ECG is a guide to use
Signup and view all the flashcards
High Importance?
High Importance?
Signup and view all the flashcards
ACS management recommendation?
ACS management recommendation?
Signup and view all the flashcards
Red blood cell transfusion recommendation?
Red blood cell transfusion recommendation?
Signup and view all the flashcards
Importance of Top Take-Home Messages
Importance of Top Take-Home Messages
Signup and view all the flashcards
Guideline-Directed Medical Therapy scope in ACS
Guideline-Directed Medical Therapy scope in ACS
Signup and view all the flashcards
ACS treatments?
ACS treatments?
Signup and view all the flashcards
Treatment goals?
Treatment goals?
Signup and view all the flashcards
Top goals for cardiac shock?
Top goals for cardiac shock?
Signup and view all the flashcards
When angiography is dangerous?
When angiography is dangerous?
Signup and view all the flashcards
For low HGB & no active bleed?
For low HGB & no active bleed?
Signup and view all the flashcards
Study Notes
2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline Aims
- The guideline incorporates new evidence since the 2013 ACCF/AHA ST-Elevation Myocardial Infarction Management Guideline and its 2014 non-ST-Elevation Acute Coronary Syndromes counterpart.
- It also considers the 2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for ST-Elevation Myocardial Infarction.
- This new guideline and the 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization both replace the 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy.
Methods for Guideline Development
- A comprehensive literature search was conducted from July 2023 to April 2024.
- The research included clinical studies, systematic reviews, meta-analyses, and other evidence from human participants.
- Studies published in English from MEDLINE, EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other relevant databases were reviewed.
- Recommendations from previously published guidelines were updated with new evidence, and new recommendations were created when supported by published data.
Focus and Key Words
- The focus is on the management of type 1 acute myocardial infarction AMI.
- Addresses dual antiplatelet therapy, high-intensity statin therapy, and interventional approaches.
- Key terms include: AHA Scientific Statements, acute coronary syndrome(s), angina unstable, anticoagulants, aspirin, atrial fibrillation, cardiovascular diseases, coronary artery disease, coronary syndrome, emergency medical services, EMS, fibrinolytic agents, hemorrhage, major adverse cardiovascular events, morphine, myocardial infarction, non-ST-segment elevation myocardial infarction, percutaneous coronary intervention, prehospital, revascularization, risk, ST-segment elevation myocardial infarction, time factors, treatment outcome.
Recommendations
- Dual antiplatelet therapy with ticagrelor or prasugrel is preferred in patients with ACS undergoing percutaneous coronary intervention.
- For those scheduled for invasive strategy but angiography delayed beyond 24 hours, clopidogrel or ticagrelor may be considered.
- Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is default for 12 months in ACS patients without high bleeding risk.
- Strategies to reduce bleeding risk include proton pump inhibitors for gastrointestinal risk, transitioning to ticagrelor monotherapy after 1 month, or aspirin discontinuation with a P2Y12 inhibitor.
- High-intensity statin therapy and the option to initiate concurrent ezetimibe is recommended for all.
- In non-ST-segment elevation ACS with intermediate or high-risk, an invasive approach is recommended during hospitalization.
- For low-risk non-ST-segment elevation ACS, a routine invasive or selective invasive approach with risk stratification is recommended.
- A radial approach is preferred for PCI to reduce bleeding and vascular complications.
- Intracoronary imaging is recommended to guide PCI with complex lesions.
- Complete revascularization is recommended in ST-segment elevation myocardial infarction or non-ST-segment elevation ACS.
Addressing Disparities
- This guideline addresses continued provider education, better understanding barriers to accessing quality care, and changes to address social determinants of health.
Selection of Writing Committee Members
- Composition includes general cardiologists, interventional cardiologists, cardiovascular surgeons, critical care cardiologists, emergency physicians, cardiac imaging experts, advanced practice nurses, clinical pharmacists, and lay/patient representatives.
- Representatives include members from AHA, ACC, American College of Emergency Physicians (ACEP), National Association of EMS Physicians (NAEMSP), and Society for Cardiovascular Angiography and Interventions (SCAI).
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
