Every one talks about coronary excesses ! It happens both in acute and chronic fashion , not withstanding the inappropriately understood . . . appropriately released guidelines on inappropriateness ! The burden of coronary syndromes of the humanity, I am afraid would include these man made excess as well !
I stumbled upon two small “gems ” in this other wise wild dark cardiology literature .One from Kamaer , Netherlands and other from Escaned from Spain.
Both talk about a simple and logical modality in the management of STEMI . If bulk of the STEMI events are due to coronary thrombosis just tackle it . “No more . . . no less” Stent only , if there is tight residual lesion.
1. From Amsterdam , Holland.
2.This one is from Spain.These studies I am sure , only a fraction of the interventional community would have read .Reason ? We are always hijacked by the moments of glamor ! I am just sharing them .hope few are benefited
These two studies with total number of 44 patients has a potential to redefine the entire practice pattern of acute interventional coronary care.(Of course , if only , we are ready to make sense out of it !)
But , the concept will be heavily banished by strong visible and invisible forces for the simple reason it suggests a true possibility of knocking out the role of stent from acute STEMI arena.
When I discussed with my colleagues for a large scale study on isolated thrombus aspiration in STEMI , they told it is not possible for ethical reasons !
I was amused , denying such a study is biggest ethical blow to the field interventional cardiology !
Final message
Proof of concept does not require numbers .A study with less than 50 subjects can be far superior than multi-centre ,multi-blinded , self steered ,peer reviewed largesse ! The truth of the study lies in the core consciousness of people who do it , not in the numbers and exotic statistical methods !.
After all , one of the greatest medical study was done by James Lind (Father of RCT) who discovered vitamin c as an antidote for scurvy, with a hand full of sailors while they crossed the Atlantic many centuries ago !
After thought
You say , thrombus aspiration is great , Why the hell , TAPAS , INFUSE AMI, and TASTE studies confuse us regarding thrombus aspiration ?
Don’t blame it on thrombus aspiration .We do it perfectly . It is because of what we do after that ! We decorate the coronary lumen finally with a piece of metal cherry undoing all the goodness of a great pudding !
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Dr.S.Venkatesan MD 