Patient handout

STEMI in prior-CABG patient (graft failure or native progression)

PRODUCTION

1. Your condition

This handout is for stemi in prior-cabg patient (graft failure or native progression). Your care team identified this based on: patient with documented prior cabg presents with new stemi on ecg.

Other reasons your team may use this plan: new st elevation on ecg in patient with prior cabg — emergent cath with graft + native angiography; recurrent ischemic chest pain in prior-cabg patient + acute ecg change → emergent cath.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
aspirin	162-325 mg chewed if not already on; continue 81 mg daily	PO	load + 81 mg daily indefinitely	AHA 2025 ACS Class I; lifelong post-MI + post-CABG
ticagrelor	180 mg load → 90 mg BID	PO	BID × 12 mo default DAPT	PLATO PMID 19717846; preferred over clopidogrel post-MI
heparin	70-100 U/kg IV bolus	IV	bolus → infusion per ACT	AHA 2025 Class I peri-PCI anticoagulation
atorvastatin	80 mg	PO	daily indefinitely	PROVE-IT PMID 15007110; intensified post-CABG given graft attrition
evolocumab	140 mg SC q2w	SC	q2w	FOURIER PMID 28304224 — additive LDL reduction + MACE benefit; appropriate for recurrent ACS in post-CABG patients with elevated LDL
carvedilol	3.125 mg BID titrate	PO	BID	CAPRICORN PMID 11356436 — post-MI BB benefit
warfarin	5 mg daily; INR 2-3 × 3 mo	PO	daily	AHA 2022 Class IIa 3-mo AC for LV thrombus

Plan: Post-CABG STEMI phenotype — adds embolic protection + intensified secondary prevention to parent cardio.stemi.core.v1 regimen

3. When to call your provider

Contact your care team if any of the following happen:

ICD therapy delivered → urgent EP
Recurrent ACS → repeat cath + heart-team

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Intra-procedural distal embolization during SVG-PCI with TIMI flow 0-1 (no-reflow phenomenon) despite patent epicardial vessel(life-threatening)
Post-CABG STEMI + SCAI C+ shock + multivessel native disease + multi-graft failure → redo-CABG vs MCS-bridged PCI heart-team decision(life-threatening)
Angiography shows multivessel native disease (LAD + LCx + RCA territories) with failed grafts — culprit may not be obvious; staged complete revascularization decision
Post-CABG patient on chronic amiodarone / sotalol presents with STEMI + new arrhythmia or QT prolongation — drug toxicity vs ischemia driven

5. Follow-up

Cardiology + heart-team follow-up; heart pumping strength (LVEF) re-echo at 40-90 d for ICD eligibility (MADIT-II EF ≤30); cardiac rehab; intensified secondary prevention; consider redo CABG evaluation if multivessel + recurrent symptoms

6. Sources

Guideline: 2025 ACC/AHA ACS Guideline (SVG-PCI section) + ESC 2023 ACS + FOURIER PCSK9 + heart-team paradigm