Failed thrombolysis is a well debated concept, while failed primary PCI is a conveniently neglected phenomenon .
How to assess successful reperfusion following PCI or thrombolysis?
I do not know how many of us know this vital fact !
Coronary angiogram is squarely beaten by the humble ECG in assessing the effectiveness of myocardial reperfusion . This is not hard to understand as coronary angiogram * can tell us only about epicardial patency , while ECG sends vital perfusion data from within the myocytes ! Which do you think is superior ?
And now interventional cardiologist have realised this fact . they measure the ST segment regression instantly once the primary PCI is completed . How ? An ECG is recorded from right inside the infarct related artery .
*Of course myocardial blush score , TIMI frame count are poor alternatives !
This paper just published in CCI is a fascinating revelation .
http://onlinelibrary.wiley.com/doi/10.1002/ccd.23455/abstract
Dr.S.Venkatesan MD 
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