What is an acute MI?
It is defined as the is chaemia of the cardiac muscles due to an obstruction to any of the arteries that supply the heart (coronary arteries). Among many causes, The obstruction mainly occurs due to the deposition of atherosclerotic plaques in coronary arteries. There are two types of myocardial infarction (MI). They are acute ST-elevation MI (STEMI) and acute non-ST-elevation MI (NSTEMI). NSTEMI is brought on by a minor arterial blockage or a large artery that is partially blocked whereas STEMI results when a major artery is entirely blocked by a burst plaque1.
With primary percutaneous coronary intervention (PCI) or fibrinolytic therapy, coronary artery reperfusion of the infarct-related artery lowers mortality for the majority of patients with acute STEMI compared to no reperfusion. Reperfusion should be used as soon as feasible because its advantages quickly deteriorate over time.
Patients who are moribund at the time of presentation and are anticipated to have a poor quality of life, those with another severe ailment, and those who present extremely late in the course of their illness are among those for whom it is prudent to refrain from offering reperfusion.
What is primary angioplasty?
Surgery to unblock a blocked coronary artery and restore blood flow is known as percutaneous transluminal coronary angioplasty (angioplasty). It is a form of balloon angioplasty and percutaneous (through-the-skin) coronary intervention (PCI). It is referred to as primary angioplasty when done on patients who have just suffered a myocardial infarction. For individuals with STEMI, a change observed with an electrocardiogram (ECG) during chest pain, primary angioplasty is an option to thrombolysis, a clot-dissolving medication therapy.
When primary percutaneous coronary intervention (PCI) can be carried out by trained interventional cardiologists quickly, it is preferred over fibrinolytic treatment. The procedure should be carried out within 90 to 120 minutes of the initial medical interaction.
Even when it cannot be done quickly, primary PCI may be chosen for some patients. Patients with uncertain diagnoses, those at high risk of bleeding, and those with high mortality risk, such as those in cardiogenic shock, are some examples of individuals for whom even delayed PCI (>120 minutes from first medical contact) is desirable.
Why it is the top-notch savior?
Compared to in-hospital thrombolysis, primary angioplasty has advantages in terms of mortality and composite end goals (Level 1 evidence).Randomized trials comparing fibrinolysis vs balloon angioplasty provide the first data to support the choice of primary PCI. These studies indicated that balloon angioplasty had an overall absolute risk of death that was roughly 2% lower. Studies demonstrating that PCI with stenting reduces the rate of death, nonfatal reinfarction, or stroke compared to balloon angioplasty were conducted in response to this evidence. Finally, in numerous randomized trials, primary PCI with stenting was directly contrasted with fibrinolysis. According to these studies, PCI carries a trend toward a reduced risk of death compared to fibrinolysis and a decreased risk of subsequent MI. Studies that assessed a pharmacoinvasive strategy, like the STREAM trial, provide additional evidence in favor of a general preference for primary PCI.
Conclusion
Primary angioplasty is widely recognized as the best therapy available for acute MI in most clinical scenarios based on a variety of clinical studies. Therefore, it remains the top-notch savior of patients with acute MI.
References
- Secretariat MA. Primary Angioplasty for the Treatment of Acute ST-Segment Elevated Myocardial Infarction: An Evidence-Based Analysis. Ont Health Technol Assess Ser. 2004;4(10):1. Accessed September 23, 2022. /pmc/articles/PMC3387753/
- Acute ST-elevation myocardial infarction: Selecting a reperfusion strategy – UpToDate. Accessed September 23, 2022. https://www.uptodate.com/contents/acute-st-elevation-myocardial-infarction-selecting-a-reperfusion-strategy
