2) . . . Supported by Abbott, AstraZeneca, Bayer, Chiesi, NovoNordisk. Follow this thread for credit. And here is a case . . .
— cardio-met (@cardiomet_CE) February 22, 2021
4) Other PMH: Crohn’s on chronic steroid therapy, budenoside & mesalamine; prostate cancer s/p XRT. Chest pain mildly improved with NTG and ASA given by EMS. He has no associated SOB. Initial ECG at 2011: pic.twitter.com/nVvOEsac5C
— cardio-met (@cardiomet_CE) February 22, 2021
6) Would you wait for results of COVID test? Do you believe Primary PCI is indicated in IWSTEMI in a Killip 1 patient?
— cardio-met (@cardiomet_CE) February 22, 2021
8) Please answer the three polling questions and return tomorrow for more on this case! Angiograms to come. @cardiacpolymath @SVRaoMD @mmamas1973 @DocSavageTJU @fischman_david
— cardio-met (@cardiomet_CE) February 22, 2021
10) Primary PCI is more effective to restore TIMI 3 flow and has a lower bleed risk. Lysis is associated with ~50% reperfusion, resulting in high need for rescue PCI. This can result in prolonged ICU stay with exposure to multiple HCPs & limiting ICU beds for COVID-19 patients.
— cardio-met (@cardiomet_CE) February 23, 2021
12) And re preloading: Guidelines recommend IV anticoag + DAPT (ASA+P2Y12i) as early as possible before angio. Inhibition of platelet aggregation after oral P2Y12i is both reduced and delayed in STEMI patients . . .
— cardio-met (@cardiomet_CE) February 23, 2021
12) And re preloading: Guidelines recommend IV anticoag + DAPT (ASA+P2Y12i) as early as possible before angio. Inhibition of platelet aggregation after oral P2Y12i is both reduced and delayed in STEMI patients . . .
— cardio-met (@cardiomet_CE) February 23, 2021
16) Return tomorrow for angiograms and further discussion. You are earning #CME and CE while you learn! @academiccme #cardiotwitter #medtwitter #cardiology @GameofAcademics @CCFcards @CCPharmacists @SnayCardsPharmD @CathLabDigest
— cardio-met (@cardiomet_CE) February 23, 2021
16) Return tomorrow for angiograms and further discussion. You are earning #CME and CE while you learn! @academiccme #cardiotwitter #medtwitter #cardiology @GameofAcademics @CCFcards @CCPharmacists @SnayCardsPharmD @CathLabDigest
— cardio-met (@cardiomet_CE) February 23, 2021
20) pic.twitter.com/5ECoSX7Qvo
— cardio-met (@cardiomet_CE) February 24, 2021
22) In view of inferior ST elevation, we decided to inject culprit first with intention of direct PCI followed by diagnostic angiography of left coronary. We engaged the RCA with a 6F JR4 guiding catheter. The culprit lesion was located in the mid RCA with TIMI 2 flow. pic.twitter.com/nG1hkjTM7y
— cardio-met (@cardiomet_CE) February 24, 2021
24) Then we completed coronary angiography pic.twitter.com/jJq65YwJsx
— cardio-met (@cardiomet_CE) February 24, 2021
28) In hindsight, had we performed diagnostic coronary angiography before PCI, our strategy might have been different, possibly with plain balloon angioplasty to the culprit lesion. What would you do next with the significant LM lesion?
— cardio-met (@cardiomet_CE) February 24, 2021
30) Return tomorrow for poll results, more discussion, and your link for free 0.5h CE/CME for physicians, pharmacists, and nurses! @academiccme #cardiotwitter #medtwitter @MedTweetorials #RadialFirst
— cardio-met (@cardiomet_CE) February 24, 2021
32) Complete revascularization in STEMI with multivessel CAD is associated with improved outcomes. In general, staged PCI is favored, unless the patient is stable and the non-culprit lesion is simple.
— cardio-met (@cardiomet_CE) February 25, 2021
34) However, in our patient with bifurcation LM CAD, a Heart Team approach that considers CAD complexity, patient factors (STS PROM), and patient preference is recommended. pic.twitter.com/7vTtkDG64d
— cardio-met (@cardiomet_CE) February 25, 2021
36) . . . mostly because our patient had no significant comorbidities. However, the issue of antiplatelet treatment while waiting for CABG poses a dilemma. How would you manage antiplatelet tx in a post-STEMI patient with a fresh stent & now needs CABG? . . .
— cardio-met (@cardiomet_CE) February 25, 2021
38) pic.twitter.com/YuQSTaG2Qx
— cardio-met (@cardiomet_CE) February 25, 2021
40) In very-high-risk patients in whom cessation of antiplatelet therapy before surgery seems to carry a high risk (e.g. within the first weeks after stent implantation), it has been suggested to switch, before surgery, to a short-acting IV antiplatelet agent.
— cardio-met (@cardiomet_CE) February 25, 2021
42) Cangrelor was associated with consistent platelet inhibition and lower risk of thrombotic events. Small molecule GPIs (tirofiban, eptifibatide) are alternatives for bridging but have slower offset of action (4-6 hours) and require dose adjustment in patients with CKD.
— cardio-met (@cardiomet_CE) February 25, 2021
43) So you made it! Free CE/CME! Physicians, pharmacists, nurses: go to https://t.co/4FP1JPhw3r and claim your credit! I am @DrMauricioCohen. Follow @cardiomet_CEfor more tweetorials! #medtwittter #cardiotwitter #cardiology #CME
— cardio-met (@cardiomet_CE) February 25, 2021