Hot debate in STEMI
Acute total obstruction (ATO) of coronary artery is an emergency .Opening it by pharmacological or catheter is the standard ( logical ) protocol.However, time plays a crucial role in this coronary re-perfusion game.It can either be a sure shot of success or end up in total spoilsport. One more issue as important as time is from the overflowing scientific data fired by different regulators in conflicting directions (Also called knowledge) .
What to do with STEMI coming late ?
- ATO with cardiogenic shock is an absolute emergency at any time.
- Symptomatic ATO other than CS beyond 24 hrs still considered emergency for most.(Symptom should be true angina )
- Hemodynamic instability is misunderstood term . Stabilizing it medically is not forbidden.
Asymptomatic stable ATO beyond 24-72 hours can be semi emergency, true emergency or as cool as a cucumber depending upon the cardiologist’s wisdom , experience or inexperience and the Institutional Integrity !
*Please be reminded ,LV dysfunction is not an absolute indication for urgent intervention unless it is due to ischemic dysfunction attributable to a critical non IRA lesion
When does a ATO become safe CTO ?
1 month , 3 months, 6 months ?
Why we are not defining a sub-acute ATO ? or CTO in transition ?
Is living peacefully with sub acute ATO or CTO a coronary crime ?
We don’t require a debate , whether these questions are worth answering or not !
Final message
Though cardiac professional are committed to open up occluded arteries to save lives , reality is repeatedly teaching different stories ! The greatest danger of keeping an artery open( In disputed indications ) is the newly conferred risk of sudden closure and the attendant unpredictable aftermath !
Or should we conclude : Living with CTO is ok , but don’t intentionally create one by denying PCI in late post STEMI ATOs
Anti-thought
Arguing closed artery is better than an open artery is straw man argument and inability to interpret positive things in science. However it may still be right when science suffers from hostile incursions from non academic forces.
Dr.S.Venkatesan MD 
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