Critical gaps in STEMI knowledge base : What is the relationship between “ Time window ” and “ Age ” of IRA thrombus ?
Cardiologists are grappling with at least half a dozen time windows in the management of STEMI. (It can be combinations of any of the following :Symptom – DAPT Loading – Door – Needle /Balloon-Sheath, wire crossing etc ) Time windows are Important in choosing the right (or no)modality of re-perfusion . Though superiority of primary PCI is thought to be established in academic community , it may not be in real world. Published studies that suggest pPCI is superior to lysis at any time window still lack good evidence.
Why is this long drawn confusion ?
One of the important determinant of outcome in STEMI , is the thrombus organisation (hardening )time . Some how we have assumed PCI can tackle hardened thrombus much better than lysis (In fact the outcome in late PCI is as bad or good as lysis in terms of true myocardial reperfusion in this population.This fact will not be visible in scientific data that’s read superficially .One has to mine deep for the truth) (Claeys MJ,. . Arch Intern Med. 2011;171(6):544–549)
Two more virtual pathological Time windows.
While we are preoccupied with certain time windows in STEMI ,may I suggest two more Invisible pathological windows. I don’t know , whether these are presumptive theoretical stuff , but understanding these time windows will sharpen our decision-making skills in STEMI.
1.Symptom to ATO time (Acute total occlusion)
ery gets occluded(ATO ).This is truly Invis...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: dr s venkatesan Tags: cath lab tips and tricks PCI PTCA Hardware Primary -PCI STEMI STEMI -Managment STEMI-Primary PCI Thrombolysis how to estimate the age of thrombus in stemi acs soft vs hard thrombus in stemi thrombus hardening time thrombus organising t Source Type: blogs
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