Myocardial salvage is like coronary fire fighting.When fire is fought very early after the accident , benefits are accrued more . Text book primary angioplasty is . . . fire engine arriving at the scene when the house is on fire .
Rescue angioplasty is asking for more force , when the initial fire fighting was inefficient to control the fire. So , it is obvious the rescue efforts should be fast and brisk.In fact the pace should me more than the primary (The the second engine should reach the ground zero faster than the first ! – Read as door -balloon time ! )
But what happens in real world ? We would tell time window for primary angioplasty even in sleep ! but will struggle to come with clear cut answer for the same in rescue angioplasty even in a fully awake state !
It is an overwhelming fact , we have not taken enough efforts to define strict time limit for rescue .( Even though guidelines say it should not be beyond 24 hours , common sense will tell us rescue PCI should not go beyond 12-15 hour window ! .One more definition for rescue PCI could be within 3 hours after diagnosing failed thrombolysis. In real world it is a race against time in a different perspective .In many centers rescue angioplasty “enjoys time less windows “
I was funny witness in a big private hospital when a colleague of mine has posted a case for “elective rescue angioplasty” and was waiting in the side cabin for his turn !
Coming back to the title question
Why we often follow a reckless time window for rescue Angioplasty ?
The reason is simple
Time is not only muscle . . . time is money too !