Ten points which an interventional cardiologist must explain to referring physician
Dr K K Aggarwal
1. That ECG can be normal in acute MI
2. That acute onset LBBB often has underlying acute CAD
3. That among patients treated with fibrinolytic drugs for STEMI there are two types of failed therapy: primary failure and threatened reocclusion. Immediate percutaneous coronary intervention is the treatment of choice for both forms. It is called rescue or salvage PCI when performed after primary failure.
4. That coronary artery reperfusion with either PCI or fibrinolytic therapy improves clinical outcomes in nearly all groups of patients with an acute STEMI who present within 12 hours of symptom onset.
5. That for STEMI patients who present within 12 hours of symptom onset, do primary PCI rather than fibrinolysis if PCI can be delivered within 120 minutes of first medical contact by skilled practitioners
6. That primary PCI should be performed within 90 minutes for patients who arrive at or who are transported by an emergency medical service to a PCI-capable hospital. Patients who arrive at or who are transported to a non-PCI-capable hospital should be transported urgently to a PCI-capable hospital if they can receive primary PCI within 120 minutes of first medical contact.
7. That for patients who cannot receive timely primary PCI, fibrinolytic therapy should be given. Fibrinolytic therapy should be administered within 30 minutes of first medical contact, and sooner if possible.
8. That for patients who present after 12 hours (and up to 24 hours) of symptom onset who have evidence of ongoing ischemia, do PCI as opposed to no reperfusion therapy
9. That for patients with severe heart failure, hemodynamic, or electrical instability, do primary PCI as opposed to no reperfusion therapy
10. That for patients who appear to have a large area of myocardium at risk or hemodynamic instability and for whom PCI is not available, give fibrinolytic therapy as opposed to no reperfusion therapy