Primary PCI (pPCI) is a glorious revascularization strategy for STEMI practiced for over 2 decades but still has not proved its perceived mettle convincingly as a large population based strategy. In the mean time, the utility value of thrombolysis was systematically (Intentionally too! ) downgraded in the minds of both academic and public mind.
Truth can’t be buried for long. Series of revelations are coming up restoring the superiority of early thrombolysis over pPCI even in PCI capable centers.
In 2013, the high Impact STREAM trial argued for pharmacoinvasive approach within 3 hrs as it was at equipoise with a pPCI. Now, EARLY -MYO from China vouch for pharmaco- Invasive approach till 6 hours. (Just published in Circulation September 2017 )
I think we need to wait for some more time , for another prevailing falsehood that need to be busted ,(Looking out for some straight thinking new generation cardiologist to do it !)
What is that ?
Many of us have misunderstood(rather made to !) that pharmaco Invasive has a defined therapeutic endpoint ie taming & stenting the IRA . This is absolute ignorance happening even in state of the art centres ,ironically this beleaguered concept is backed by peer-reviewed papers from premier journals. The fact of the matter is , If thrombolysis is stunningly successful (Which at the least happens in 50 % ) one can stop with that , it’s also a therapeutic endpoint at least for time being .
Is coronary angiogram a baseline test like ECG ?
That’s what current cardiologists with cutting edge knowledge seem to believe ! Do you agree ! I am sure I’m not !
Patients with STEMI who had successful thrombolysis who had an apparently uncomplicated course (Assessed by strict clinical ECG, ECHO criteria) need not go for coronary angiogram in the immediate future.In fact some good guidelines strongly argue for it and call it as Ischemia driven PCI ! but very few seem to respect that concept.)This will not only contain the cost and ensure the vast majority of Inappropriate ( scientific quackery) coronary plumping activity in human race.
Searching for an elusive data ! Can some one help ?
I have been searching for data , from all those major pharmaco invasive studies (Which is not being reported /shared or analysed )
How many patients in the “success cohort” after thrombolysis who subsequently land up with urgent PCI related complications when trying to stent an already reperfused IRA or while tackling coexisting Innocent or non-innocent non IRA lesions ?
* Complications and adverse events may be acceptable in patients who had failed thrombolysis or who are unstable but even minor adverse events are forbidden in patient with a truly successful and asymptomatic patient.
Final message
So called scientific facts have very short half life ! for the simple reason they are let loose in human domain prematurely !
Reference
Dr.S.Venkatesan MD 