What is the most important factor that will decide the revascularsation following a STEMI ?
- Patient’s symptoms
- Residual Ischemia documented by stress test /Perfusion scan
- Presence of significant LV dysfunction
- Coronary anatomy and lesion profile
- Wealth of the patient (Insurance limit and other financial resources )
Response 2 is academically correct , but practically and politically response 5 would be the right one for most cardiologists . At any given day , affordability and availability of PCI will prevail over all other factors .
Image courtesey : Jupeter images
What is the height of inappropriateness in modern cardiac care ?
This world will never forgive the medical profession , if they do not fight against grossly inappropriate medical care system especially in the life saving situations .While one cardiologist just watches a left main disease patient with unstable angina die peacefully in a Govt institution , while another patient with asymptomatic distal PDA lesion gets a 3rd generation drug eluting stent in a nearby corporate hospital !
Please note : Harm is the ultimate outcome in both rich and poor.One suffers with non availability while the other is the victim of affordability .