STEMIis numero uno of any medical emergency . The risk of death is maximum in the first hour.
Here is a patient who presented within 30 minutes of chest pain.Enzyme sample was just sent and a bed side echo revealed a severe wall motion defect in LAD region.
What would have been the response from a current generation cardiologist ?
- Alert the cath lab . Send the patient direct to cath lab .
- This did n’t happen as we are in a underdeveloped country and the patient is poor .
- Should we worry about that l ? Not at all . . . He received a shot of much ridiculed streptokinase injection which costs 2000 Rs ( 50 dollars) in India .
And see the result yourself !
Can you imagine this man had a major STEMI just an hour back ?
Any intervention that is done immediately has a major impact on outcome. When the patient comes to you early within 3o minutes and STEMI, or actually a TEMI , T wave elevation MI or Hyper acute MI .
When the patient comes to you early cardiologist should raise to the occasion and set a new challenge .
What is that challenge ?
The aim should not to be in salvaging the myocardium , rather prevent the event of ACS and abort the MI process itself !
How is this possible ? Can you abort a STEMI or TEMI by primary PCI ?
Since one has to act fast , primary PCI is a likely loser 9/10 times in aborting a STEMI .
The best option is to do an intervention which can have almost zero door to needle time* . The good old thrombolysis administered at the door itself pips the pPCI convincingly with a huge cost saving as well .
This is what this patient received. and see the result . His angiogram later showed a fully recannalised LAD .No stent was advised .He was put on high dose statins ,beta blocker and antiplatelet agents.
*You can not balloon the patient on the arrival in door steps ! .
Final message
Do not ridicule any modality of therapy for being simple and cheap . They may be most effective as well .
Dr.S.Venkatesan MD 