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Dr. Ashwin Mehta

Primary Angioplasty In Myocardial Infarction - 8th April 2017

India is currently leading the global epidemic of coronary artery disease.  The incidence of Coronary artery disease (CAD) is as high as 12-16% in young Indians, higher than any other ethnic group. 60% of acute coronary syndromes in India present as a ST Elevation Myocardial Infarction (STEMI).  Unfortunately, Indians also get heart attacks a decade earlier than the West.  One fourth of all heart attacks occur in people younger than 40 years.  Surprisingly only 8% of these patients receive the optimum treatment, that is Primary Angioplasty in Myocardial Infarction (PAMI).

The mechanism of a STEMI is almost always a sudden and total occlusion of an epicardial coronary artery. Survival of the patients depends on how expediously the blocked epicedial artery is opened up (myocardial revascularization). 

The treatment options for patients with myocardial infarction who present within 12 hours of onset of chest pain are Thrombolysis or PAMI. Thrombolysis involves giving a clot busting medication intravenously. However it has been shown to be effective in only about half of the patients.

On the other hand, PAMI involves doing an urgent angiography and stenting to the culprit artery which has a success rate or more than 95% !!

Therefore, without doubt, the most effective method of re-establishing circulation to the infarct related zone of myocardium is Primary Angioplasty with stenting.

This will mean not only early detection of this life threatening malady, but also expedious contact with the centre which can offer coronary angioplasty round the clock by an experienced team.

When a patient comes to the hospital with symptoms suspicious of a heart attack, the ECG is done within 7-10 minutes. A cardiology registrar evaluates the ECG and if it shows ST elevations, he activates the PAMI CODE.  Immediately, another on call cardiology registrar, junior consultant cardiologist and anaesthetist are called. Each has a specified role in the management for which they have received exhaustive training.  A cardiac nurse and cath lab technician prepare the cath lab to receive the patient.

Within 20-30 minutes the patient is on the cath lab table.  He promptly undergoes a coronary angiography via his wrist or groin under local anaesthesia. The clot totally occluding this 'culprit' artery is sucked out followed by stenting. This entire procedure from the time the patient comes through the door of the hospital takes between 75-90 minutes. We pride ourselves in the successful implementation of the CODE PAMI and gratified that we live up to and even better international guidelines!

This devastating disease affects Indian more aggressively with presentation in their prime of life, with higher mortality and with majority of patients not getting the option of the best treatment - PAMI.  We are glad that we can provide this timely service to the patients who are in maximal need and we hope to change the numbers of the outcomes in our favour!