Patient handout

Radiation-induced STEMI (post chest/mediastinal XRT)

PRODUCTION

1. Your condition

This handout is for radiation-induced stemi (post chest/mediastinal xrt). Your care team identified this based on: prior mediastinal/chest xrt ≥5 years (hodgkin lymphoma, breast, lung, esophageal cancer) → consider radiation-induced cad as stemi etiology.

Other reasons your team may use this plan: st-elevation mi ecg in cancer survivor with prior chest xrt — likely ostial coronary disease; atypical/typical angina in patient <55 with prior hodgkin xrt — high pretest probability of accelerated ostial cad.

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	PO	load + 81 mg daily	ACC/AHA 2025 ACS Class I; same as parent
ticagrelor	180 mg load → 90 mg BID	PO	BID × 12 mo default DAPT	PLATO PMID 19717846; same as parent — but consider shorter DAPT if active cancer + bleed risk per ESC cardio-onc 2022
atorvastatin	80 mg PO daily	PO	daily	High-intensity statin essential — radiation-CAD has accelerated trajectory; PROVE-IT extrapolation; ESC cardio-onc 2022 PMID 36017575
lisinopril	5 mg PO daily, titrate to 20-40 mg	PO	daily	ACEi for LV remodeling + concurrent radiation cardiomyopathy substrate; AHA cardio-onc 2022
heparin	70-100 U/kg IV bolus	IV	bolus + infusion	AHA 2025 Class I; same as parent
carvedilol	3.125 mg BID titrate	PO	BID	CAPRICORN PMID 11356436; beta-blocker indicated for any radiation-related LV dysfunction

Plan: Radiation-induced STEMI phenotype — adds to parent cardio.stemi.core.v1 reperfusion regimen with cardio-onc-specific secondary prevention

3. When to call your provider

Contact your care team if any of the following happen:

Recurrent angina → return to cath — radiation-CAD has high restenosis + de-novo disease rate
New AS murmur → echo + AVR consideration (TAVR preferred over SAVR in irradiated field)

4. When to seek emergency care

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

IVUS/OCT shows severe ostial calcification + lesion morphology not amenable to PCI even with intravascular lithotripsy
CABG considered in patient with prior chest XRT — markedly elevated operative mortality + sternal wound complication rate due to radiation fibrosis + chest-wall lymphedema
Workup reveals secondary malignancy (radiation-induced sarcoma, breast cancer post-Hodgkin XRT) in radiation field during ACS admission
Echo or hemodynamics show constrictive physiology contributing to shock or HF post-MI in radiation survivor(life-threatening)

5. Follow-up

Cardiology + cardio-oncology dual follow-up; serial echo q12mo for radiation valvulopathy; high-intensity secondary prevention; smoking cessation paramount; consider repeat CTA at 5yr post-PCI

6. Sources

Guideline: 2025 ACC/AHA ACS Guideline + ESC 2022 Cardio-Oncology Guideline (Lyon PMID 36017575) + AHA Scientific Statement Cardio-Oncology 2022