STEMIis numero uno of any medical emergency . The risk of death is maximum in the first hour.
Here is a patient who presented within 30 minutes of chest pain.Enzyme sample was just sent and a bed side echo revealed a severe wall motion defect in LAD region.
What would have been the response from a current generation cardiologist ?
- Alert the cath lab . Send the patient direct to cath lab .
- This did n’t happen as we are in a underdeveloped country and the patient is poor .
- Should we worry about that l ? Not at all . . . He received a shot of much ridiculed streptokinase injection which costs 2000 Rs ( 50 dollars) in India .
And see the result yourself !
Can you imagine this man had a major STEMI just an hour back ?
Any intervention that is done immediately has a major impact on outcome. When the patient comes to you early within 3o minutes and STEMI, or actually a TEMI , T wave elevation MI or Hyper acute MI .
When the patient comes to you early cardiologist should raise to the occasion and set a new challenge .
What is that challenge ?
The aim should not to be in salvaging the myocardium , rather prevent the event of ACS and abort the MI process itself !
How is this possible ? Can you abort a STEMI or TEMI by primary PCI ?
Since one has to act fast , primary PCI is a likely loser 9/10 times in aborting a STEMI .
The best option is to do an intervention which can have almost zero door to needle time* . The good old thrombolysis administered at the door itself pips the pPCI convincingly with a huge cost saving as well .
This is what this patient received. and see the result . His angiogram later showed a fully recannalised LAD .No stent was advised .He was put on high dose statins ,beta blocker and antiplatelet agents.
*You can not balloon the patient on the arrival in door steps ! .
Final message
Do not ridicule any modality of therapy for being simple and cheap . They may be most effective as well .
Dr.S.Venkatesan MD 
if you dont have the resources….we have to do the next step….if the situation/condition permits and resources availability…use them if they are not there then try the best possible available therapy…hope for the best outcome…pray for God’s grace and miracle cause we are only instruments of His miracles….
the research and studies have shown how when where why and …we are still in search for more..use what is available they worked in the past they might still work today…lets do our best for the sake of the patient…
Dr. Alcantra’s comment makes a lot of sense. Thanks !