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Lipid Lowering and Antiplatelet Strategies Post-ACS: A Case-Based Discussion

  1. According to the 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation, which of the following is recommended for maintenance antithrombosis after STEMI?
    DAPT consisting of aspirin plus ticagrelor or prasugrel for 12 months after PCI, unless there are contraindications such as risk of excessive bleeding
    Triple antithrombotic therapy consisting of aspirin, oral anticoagulation, and ticagrelor or prasugrel
    In patients with stent implantation, triple therapy for 12 months
    In patients at high ischaemic risk, ticagrelor 120 mg twice daily may be continued for a maximum of 18 months.
  2. A 62-year-old man with a history of hypertension is admitted to your hospital 2 hours after an inferior STEMI. This is the patient's first myocardial infarction. Prior to this event he had been taking chronic rosuvastatin 20 mg. His LDL-C level was 3.2 mmoL/L at admission. He underwent PCI of the right coronary artery with the placement of 2 stents.
    How would you treat this patient in an effort to help him meet the target lipid level outlined in the 2019 ESC/EAS guidelines for the management of dyslipidemias?
    Increase the statin dose to the highest recommended dose
    Double the statin dose and add ezetimibe to the treatment regimen
    Continue current statin treatment and add ezetimibe and a PCSK9 inhibitor to the treatment regimen
  3. The ACS Lipid EuroPath III working group identified strategies for improving the handoff between physicians caring for hospitalized patients post-ACS to their outpatient care providers (eg, general practitioners [GPs]).
    Based on the working group's recommendations, which change would you prioritize for your hospitalized patients to help the physicians who will provide their outpatient care to improve patient outcomes?
    Standardize the discharge letter
    Educate GPs on lipid-lowering therapies
    Manage patients' concerns about taking medications long-term
    Develop a lipid-lowering assessment tool for GPs to use