FAQs in STEMI : Why is the 3 hour gap recommended before pharmaco Invasive strategy?

Background STEMI knowledge check : Evidence-based Ignorance I think , It was unfortunate, In the management of STEMI , the two popular strategies of myocardial reperfusion was made to fight with each other as if they are perennial enemies for over two decades. Suddenly, someone with a rare coronary insight thought, why fight each other , they can have a friendly hug and work together. That brought the concept of pharmco -Invasive approach or strategy(PIA) backed up by STREAM, FAST-MI, and TRANSFER AMI studies.Yes, it appears to work well and devoid of all the early adverse events of pPCI. (Much to the dismay of ardent fans of Primary PCI ) *May I add one more shocker of a fact . Deep subset data mining from the above trials did show very early lysis may even act as a perfect stand-alone therapy negating the need for acutely one pharmaco Invasive PCI altogether.(Which was never published) Don’t get alarmed the concept is nothing but , the good old lysis , followed by leisure & elective Ischemia guided PCI in all uncomplicated STEMI. Now coming to the FAQ in Cardiology Boards: Why is the time window for PIA is 3 to 24 hrs ? The simple answer for an uncomplicated fellow is “published studies have shown benefit only in this time window. If you do PCI early (,<3h) after lysis paradoxically both bleeding and pro-thrombotic complication over the stented lesions are more common. The upper limit is 24 hrs , since by that time we lose all the potential for myocardia...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: acute coronary syndrome Cardiology - Animations Cardiology -Interventional -PCI Cardiology -unresolved questions cath lab tips and tricks Infrequently asked questions in cardiology (iFAQs) open artery hypothesis STEMI STEMI -Managment ST Source Type: blogs