Does the “ Non -IRA ” lesion status confuse you often ?..Try a blind primary PCI !
Primary PCI of IRA , continues to be a clinically & statisticaly validated (Inspite of some ifs & buts) coronary reperfusion strategy.
What to do, if we happen to detect, a significant or borderline lesion in non- IRA territory ?
There are too many guidelines scattered across cardiology literature either to “help or confuse” us. They argue for either immediate intervention , defer transiently, postpone or just ignore it , based on clinical ,hemodynamic*, Individual, institutional , or some other non academic factors. (Permanently deferred PCI is other wise called medical management is practiced by some GPs who never refer such patients to higher centers after a stand alone thrombolysis)
* The FFR, iFR RFR, related stuff
What if if we are completely blinded to the status of Non IRA vessel ?
What do mean ?
I mean , can we be, “not- aware” of contra-lateral lesion status ?
Yes, “Simply don’t do a non IRA angiogram , that’s it. If its RCA PCI , don’t shoot Left main, and vice versa for LAD. Do a PCI without doing a completed CAG. I mean IRA PCI alone, by guessing it by ECG .
What a crazy Idea ?
This week’s JAMA has something* remotely relatable to this idea. The aim was to do PCI before complete CAG , to document any advantage. (It is important to note, CAG was done in all patients)
Click to access levi_2024_oi_240163_1711065732.05999.pdf
Did this study really happen ...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
More News: Academia | Angiography | Cardiology | Emergency Medicine | Eyes | Heart | Learning | Legislation | Medical Ethics | Statistics | Study | Thrombosis