My name is Inezia Zindu, I'm a new faculty member at UT Southwestern and a North Texas VA. And today I'll be talking about a case I saw recently. So I've only been faculty about three weeks and it was a little bit challenging to try and find a case quickly, but this was actually my first STEMI activation at Parkland Hospital. I just want to thank Sky for inviting me and I'm really excited to have this discussion with this expert panel. So I don't have any disclosures. So this was, again, this is about two weeks ago, and we had an 81-year-old male that was presenting with a STEMI from out, after out-of-hospital cardiac arrest. And there's a, often you'll see transient ST elevation after out-of-hospital cardiac arrest, so I often have the ED repeat the EKG and we saw that the ST elevation was persistent in the anterior lateral leads. When you have that transient ST elevation, often it's knocked forward, it doesn't correlate with acute vessel closure, but this was persistent and we went ahead and activated the cath lab. So for the story for him, he was an 81-year-old, has a history of atrial fibrillation and sick sinus syndrome with a permanent pacemaker in place. He was actually going through the airport when he noted that he started having some chest pain and then collapsed. It took a little bit of time for bystanders to recognize he was having a cardiac arrest, but then they started CPR, EMS arrived, they defibrillated him for, twice for ventricular fibrillation, and then he attained ROS in the field and then was emergently transported to the ED. On ED arrival, he was intubated, but he was actually hemodynamically stable, but he was non-purposable, so we thought that after doing our coronary angiogram, we'd probably put in a target temperature management system and we can talk a little bit about that, I guess, in a different discussion. So I usually do the non-NPARC vessel first, but he did have an anomalous right coronary, so I went down and took a little bit of time to try and find the right coronary, so just went ahead and switched over to EBU and going after my NPARC vessel. It may be a little bit hard to appreciate here, but he had a mid-LED occlusion right after the takeoff of that diagonal. And so this is a point where I already start kind of thinking decision-wise what antithelic therapy I'm going to use and then obviously timing, and I think obviously we'll have some great conversation about that. But I think there's obviously some important variables with this patient in particular. He's coming with acute coronary syndrome and ST elevation MI. You know, right at that time, he was hemodymatically stable, but if I potentially think he might need mechanical circulatory support and need anticoagulation with large floor access, does that affect my antithelic therapy strategy? And then also in cardiac arrest, we do know that about 10 to 20 percent of patients actually have stent thrombosis after revascularization after out-of-hospital cardiac arrest. Obviously, there's that large ischemic injury, global ischemic injury, poor gut absorption, and then finally targeted temperature management of itself. Hypothermia can activate ADT-induced platelet aggregation, so it changes the milieu in which your antiplatelets are going to be working. That would be the, I guess, initial portion of my talk.

STEMI

cardiac arrest

antithrombotic therapy

mechanical circulatory support

stent thrombosis