Q&A
Q
Regarding STEMI, have you used any lytics in the last month?
A.
Not lyrics for STEMI at all yet at Sinai. Now we have changed the protocol to do PPCI even in Covid-19 STEMI cases.
Q
In which cases will you use lytics with the present information?
A.
Only in transfer cases, where system delay (due to unavailability of ambulance or staff) is perceived to be more then 2-3 hrs; which is very unlikely.
Q
So, should one do the Rapid test or not?
A.
I suggest not to use the current Abbott’s Rapid Covid-19 test as it can be false negative in 30-40% of cases.
Q
Or, rely solely on a better history?
A.
History of Covid exposure and symptoms are also not fully reliable and can be negative in 1/3rd. Chest Xray has 90% sensitivity and CT chest has 98% sensitivity. Hence we still have to resort to a better Covid-19 test.
Q
Or, get a CTA?
A.
CT chest is very sensitive and specific.
Q
Any difference in how you approach the Primary PCI procedure?
A.
Yes Impella will be appropriate in STEMI PCIs with severe LV dysfunction especially in non-Covid pts. In Covid pts, Impella use in this scenario has to be very judicious to minimize the potential staff exposure to the virus.
Q
With severe LV dysfunction and STEMI, does Impella make sense?
A.
Yes Impella will be appropriate in STEMI PCIs with severe LV dysfunction especially in non-Covid pts. In Covid pts, Impella use in this scenario has to be very judicious to minimize the potential staff exposure to the virus.
Q
Or IABP?
A.
Same statement will be true for IABP use also just like Impella recommendations.
Q
What is your commonest DES presently?
A.
At Sinai we have 2 DES product rule; currently Xience and Synergy only.
Q
Among the lifestyle modifications that you mentioned, is there one you feel is the most beneficial?
A.
Mental and physical relaxation now and even in post Covid era is the most beneficial lifestyle modification to minimize the impact of CAD.
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