Dr.S.Venkatesan MD

Time is muscle .This  may sound as  an old fashioned statement now ,  for many of us. But the fact remains. Every minute following  STEMI ,  myocytes  keep  losing it’s life one by one unless , the  intervened.

The prevention of myocyte death can be accomplished by three ways

1. By early thrombolysis
2. By Primary angioplasty
3. The  one  that happens naturally by a process called spontaneous thrombolysis *

* Most have a  strong belief  that the  natural forces are incompetent to lyse a  small thrombus within our coronary  arteries  ( While  , we  fully  realise   natural  forces  like  the Tsunami can wash out  the entire ocean floors  ) . Never under- estimate the force of  nature !

Balloons are not privileged !

It is widely accepted , a time window of up to 12 hours is optimal for reperfusion. Beyond that time , there is no point in reperfusing  the muscle  as   it  might have died. While ,  the majority of cardiologists agree  to this and they  promptly  refuse  to thrombolyse ,   if the patient comes  12 hours after an onset of STEMI  .They are labeled  ” late on  arrival”  and  coded  as ineligible for thrombolysis.

The moment they are labeled as ineligible for lysis , a dangerous thought process runs across  the minds of  many cardiologists. It is  possibly  the most important paradox (Shall  we call it as sense failure ? )

Such lysis ineligible  patients    become  automatically eligible for primary PCI . . . It is curious  to note , the  time window for primary PCI is also less than 12 hours is strangely forgotten.

It has become a prevalent  practice  by all unscientific means  , most  cardiologists extend  the time window for primary PCI well beyond 12 hours  , some even up to 36-48 hours.  No wonder . . . then why open artery trial (OAT) miserably failed . Even a  novice  can predict the out come when  one tries  to resuscitate the  dead muscle .

Final message

Myocardium  does not behave in a privileged  manner  during a STEMI.  It  simply does  not bother  about the way  by which  it is going to be rescued and reperfused  .All it needs   is a timely help. It can not extend its   life just because it is being rescued by a  sophisticated modalities like pPCI.

If the patient is late for thrombolysis ,  he is late for  primary PCI as well .

Please do not change the time window in STEMI  according to  our  whims and fancies . It is  an  unscientific and unprofessional  way to practice cardiology .