Infarct related culprit Versus Non- culprit vessel revascularization

Infarct related culprit Vs. non- culprit vessel revascularization

A 38 year old male smoker and hypertensive presented with severe retrosternal chest pain of 3 hours duration. On examination he was hypertensive with BP = 80/50 sinus bradycardia with HR 40bpm, right sided S3 and chest clear. He recently underwent primary PCI to LAD a month ago, coronary angiogram at that time revealed LAD 90% stenosis, LCX mid 50% stenosis, RCA proximal 60-70% stenosis and Right PDA has 80% osteal stenosis.

ECG on current presentation showed sinus bradycardia and ST depressions more than 2mm in inferior leads. Please give answer of following questions based on guidelines

a) Is TPM indicated, if yes then give justification

b) Name the culprit vessel

c) Do you think revascularization of non-culprit vessel at time of primary PCI would have prevented current cardiac event

d) Name the trials which have studied such scenarios

Answers:

a. Yes, Symptomatic bradycardia
b. RCA/PDA
c. Yes
d. DANAMI, PRAGUE, CULPRIT and PRAMI Trail (Infarct related culprit Vs. non- culprit vessel revascularization)

Reference:

1. Chapter 22, page 390 – Bradyarrythmias - Manual of Cardiovascular Medicine Fourth Edition - Brian P. Griffin MD FACC

2. Engstrom T, Kelbaek H, Helqvist S, et al. Complete revascularization versus treatment of the culprit lesion only in patients with ST segment elevation myocardial infarction and multi vessel disease (DANAMI 3- PRIMULTI) an open – label randomized controlled trial. Lancet 2015;386:665-71.10.1016/S0140-6736(15)60648-1 [Pubmed]

Comments

STEMI ECG Criteria and Universal Definition of MI

STEMI ECG Criteria and the Universal Definition of Myocardial Infarction: A Complete Guide for Clinicians Early and accurate diagnosis of acute myocardial infarction (AMI) remains the cornerstone of reducing morbidity and mortality in patients presenting with chest pain. Among all forms of acute coronary syndromes (ACS), ST-elevation myocardial infarction (STEMI) represents the most time-sensitive emergency, requiring immediate reperfusion therapy. This article provides a clinically relevant summary of the STEMI ECG criteria and the Universal Definition of Myocardial Infarction (UDMI), based on the latest consensus guidelines from the ESC, ACC, AHA, and WHF. --- 1. Understanding STEMI: Why Accurate ECG Interpretation Matters A 12-lead ECG remains the first and most critical diagnostic test when evaluating suspected myocardial infarction. STEMI is identified when there is evidence of acute coronary artery occlusion, producing transmural ischemia and characteristic ST-segment eleva...

𝘼𝙣𝙩𝙞𝙘𝙤𝙖𝙜𝙪𝙡𝙖𝙩𝙞𝙤𝙣 𝘼𝙛𝙩𝙚𝙧 𝙎𝙩𝙧𝙤𝙠𝙚

𝘼𝙣𝙩𝙞𝙘𝙤𝙖𝙜𝙪𝙡𝙖𝙩𝙞𝙤𝙣 𝘼𝙛𝙩𝙚𝙧 𝙎𝙩𝙧𝙤𝙠𝙚 in Patient with AF and acute IS/TIA European Heart Association Guideline recommends: • 1 days after TIA • 3 days after mild stroke • 6 days after moderate stroke • 12 days after severe stroke Early anticoagulation can decrease a risk of recurrent stroke and embolic events but may increase a risk of secondary hemorrhagic transformation of brain infarcts. The 1-3-6-12-day rule is a known consensus with graded increase in delay of anticoagulation between 1 and 12 days after onset of ischemic stroke or transient ischemic attack(TIA), according to neurological severity based on European expert opinions. However, this rule might be somewhat later than currently used in a real-world practical setting.

2025 AHA/ACC Hypertension Guidelines Key points

2025 AHA/ACC Hypertension Guidelines Explained: A Clear Summary for Clinicians and Students Hypertension remains one of the most significant contributors to cardiovascular morbidity and mortality worldwide. With continual refinement of evidence and risk-based strategies, the 2025 AHA/ACC Hypertension Guidelines bring an updated, practical approach that clinicians can use in daily practice. To make learning easier, I’ve created a clean and modern infographic summarizing all major recommendations. You can download it below and use it for study, teaching, or clinical reference. Download Infographic (PNG): 2025 Hypertension Guideline Infographic This post breaks down the key points from the guidelines and complements the infographic for a complete understanding. --- BP Categories: Understanding the Updated Thresholds The guidelines maintain the well-established classification of blood pressure: Normal: <120 / <80 Elevated: 120–129 / <80 Stage 1 Hypertension: 130–139 and/or 8...

Dr. Usman's Cardiology Notes

Search This Blog