Management of STEMI In The Absence Of PCI | Dr. Sreenivas Kumar | The Interview | Therightdoctors

Dr. Sreenivas Kumar
Chief Cardiologist, Citizens Hospitals, Hyderabad

“Though cath lab numbers have been increasing in India, they are unevenly distributed. Majorly concentrated in the tier 1 cities, less than 5 to 10% of these facilities cater to tier 2 and tier 3 cities,” Dr. Sreenivas Kumar says in an interview with Dr. Manish Verma.
Most of the myocardial damage can be avoided if the artery can be opened and re-perfused in the first three hours. But less than 4% of the total population which suffers acute MI gets a primary PCI.To buy some time, reperfusion with thrombolytic drugs is the second best option. Newer thrombolytic agents like tenecteplas are more fibrin specific, less complication prone and have better opening rates than the old streptokinase.
“After thrombolysis, once the rhythm abnormality settles and BP becomes stable, then patients are in a better shape to be shifted to PCI centres.”
“When people are presented to a PCI center after thrombolytic therapy, 50% do not need any further procedure, because the artery is already open.”Usage of high dose statins and newer antiplatelets like ticagrelor and prasugrel is also
recommended.With that, diagnosis of MI is the only problem remaining.
To solve it, Dr. Sreenivas suggests that every physician must pair up with a cardiologist, so that ECG readings can be transmitted and confirmation regarding acute MI can easily be obtained.In a parallel conversation, Dr. Sreenivas warns that any symptom of a heart attack like
chest pain must not be neglected by presumption of acidity or gas to be the reason. “There is no reason to not treat it as a cardiac problem unless proven otherwise,” he adds.
Many issues of the dual antiplatelet therapy are also extensively discussed by Dr. Sreenivas Kumar.

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