Dr.S.Venkatesan MD

This is not a completely Imaginary conversation, between the wife of a recently discharged STEMI patient and his cardiologist. This happened in a top ranked heart care center in my city Chennai.

Caution: Strong language

Patient’s wife :

Doctor, why my husband is suffering from significant LV dysfunction in spite of a timely &  successful  primary PCI. You assured me you are doing the  best.

Cardiologist:

Yes, you are right. I am sorry, for that.

Patient’s wife :

But, doctor, on the day of discharge  you told us proudly, the procedure is 100% success and you have  relieved the block and restored blood flow. I recall, you quoted some Tomy score, and all.

Cardiologist:

Yes I did. It is not Tomy, it is TIMI 3, which we use routinely,  and … to be frank, it actually means nothing. It tells us, we have restored flow across the artery at the site of block . It can never guarantee, all those blood, will reach the ailing muscle.

Patient’ wife:

TIMI or TAMY,  doesn’t mean anything to me doctor, It sounds  like my neighbors’  pet. All I want to understand is , whether the procedure was really successful. Yes or No ?

Cardiologist:

You are correct. I am extremely sorry. It is really an Incomplete myocardial salvage. Your husband’s myocardium is significantly damaged. You must also understand , these things are not in our hands. It is the destiny that decides the fate of the myocardium. It lies deep in the myocardial  microvasculature, which  doesn’t obey our conventional time windows we talk about.

Patient’s wife:

That’s ok. But, what is the need for mis-communication to us. Why didn’t you admit it as a failed primary PCI in your discharge records ?

Cardiologist:

I agree with you. But, scientifically it is not a falsehood. For us, it is still a success, because we are  just macro-vascular cardiologist. We define success based on  removing blocks, not the true myocardial reperfusion.

Patients wife:

That’s awful. Sorry, for being harsh .For heaven’s sake please go and change your horrible definition for a successful PCI ,in the cardiology literature.

Cardiologist:

Thanks for bringing up this  less discussed entity “Failed primary PCI”  We rarely discuss about it (In the biased minds of interventional cardiologists, only thrombolysis can fail). Surely, we will pass on your genuine concern to the concerned authorities.