ADVANCED TREATMENT FOR ACUTE HEART ATTACK-THE PRIMARY ANGIOPLASTY
The Primary Angioplasty is a life saving procedure in a patient with acute (on-going chest pain) heart attack. When a patient has heart attack, the blood supply to a part of his/her heart is blocked. If the blood supply is restored as soon as possible (within first 12 hours), the damage caused by heart attack is contained. Although this can be beneficial if done within twelve hours of beginning of heart pain, but best results are obtained if the block is cleaned within 1 to 3 hours. This can be achieved by some intravenously given clot bursting drugs called “thrombolytic agents” or by emergently performed cleaning of the block by a procedure called “Primary Angioplasty”. The clot bursting treatment is commonly offered in many centers. However, such treatment opens up clogged arteries in about 60 per cent of patients. The remaining 35-40 per cent of cases are at risk of death due to failed thrombolysis [failure of drug to dissolve the clot], or even if they survive the attack, go home with a very weak heart due to a large portion of the heart muscle being permanently damaged. On the other hand primary angioplasty opens up clogged arteries in 99 per cent patients and this saves significantly more lives as compared to treatment with clot bursting agents. In addition, there is a minimal risk of brain hemorrhage with blood thinning medicines which is reduced by fifty percent if primary angioplasty is done instead of administering clot busters.
Technically, during angioplasty a balloon is used to crush blockages in the blood vessels supplying the heart [coronary arteries], thereby restoring flow of blood. These procedures are almost invariably followed by insertion of a metal scaffold called a stent which prevents recoil and reduces re-blockage at the ballooned site, which is called a stenting procedure. Balloon angioplasties and stenting techniques have become a very routine day-to-day procedure performed in most tertiary care hospital across the country. However, primary angioplasty, has to be done as a life-saving emergency procedure in a patient with on-going heart pain. This has to be performed within 90 minutes of the patient’s arrival in the hospital and thereby improving survival of heart attack victims. Else the muscle of the heart gets damaged permanently. Doing angioplasty in a critical patient of heart attack is in itself challenging and doing so in the critical window period of 90 minutes further adds to the challenge. Some times the patients reach the hospital much after the first 12 hours’ period is over or some times the accompanying relatives delay the procedure by not taking decision in time. This happens due to lack of awareness regarding the importance of each minute delay in treatment.
We at Apollo hospital offer Primary Angioplasty 24X7. In India, 2.5 million patients develop heart attack annually. However less than 7,000 primary coronary angioplasties are performed across roughly 400 cardiac catheterization labs across the country.
Dr Anupam Bhambhani. MD, DM, FESC,Senior Consultant Interventional Cardiologist.
Apollo Health City,
Apollo clinic Kondapur,
Apollo clinic Road number 36 Jubilee Hills.