Primary PCI has proven to be the best option for management of STEMI . But it need to be done very early by a an experienced team in a good facility . (Note , it is not the individual expertise that matters ! Ronalodo alone can never guarantee a match win ! )
Any treatment , which has a great therapeutic potential also carries a hazard .
So , these treatment must be used with caution. Not every STEMI patient , has a high risk of death. In fact the mortality in some of the subsets of STEMI , can be less than 1%. If , a STEMI patient with a likely 1% mortality is going to get a procedure with 3-4% , risk it is bound to raise a validity question ?
What are the situations in STEMI , where primary PCI could be dangerous*?
* The term dangerous here means , Risk > Benefit .
Side vessel STEMI : STEMI in branch coronary arteries. Main vessel STEMI(LAD,RCA,LCX ) has higher risk than side vessel STEMI( Diagonals, OMs, Septal) .
Side vessel STEMI is not easy to diagnose in ECG , but an MI with ST elvation restricted to only 2 leads could be a side vessel STEMI.
The following could be some examples.
- 1 /AVL , High lateral
- V2 V3 , Septal
- 3 AVF , PDA/RV/ Acute marginal
- V5 V6 OMs/Ramus
A spontaneously evolving STEMI , with ST segment returning towards baseline and T wave getting inverted .This indicates IRA is either partially patent and the coronary blood flow is in the salvage mode. Here , thrombolysis is going to be very effective .
In the management of STEMI , primary PCI could be consciously avoided in some of the patients to improve the overall outcome .