First Primary PCI in CMS-TH

In 2011, a 69 year old female H/O HTN, T2DM presented to our ER with 16 hour history of retrosternal chest pain, epigastric pain, vomiting with breathlessness and profuse sweating. Her BP was 80/60mmHg. ECG showed ST elevation in Inferior leads and also in lead aVR. Diagnosed as Acute Inferior wall MI with RV extension. She went into pulmonary edema and had to intubate and kept on inotropic support. 

We explained the prognosis (of course poor!) to the patient party, they wanted to take the patient home. However, we also counselled them about CAG and possible PCI stenting. After explaining about the risk/benefit of the procedure in such patients, they finally agreed for further intervention.

CAG showed proximal RCA 100% occlusion with minor plaque in left system.

CAG showing RCA total occlusion. Temporary pacemaker in RV apex

PCI stenting to RCA was done with good end result. Procedure was uneventful.

Final result after stenting showing TIMI III flow in RCA

Patient was then shifted to CCU. There was rapid improvement. TPI was removed, inotropes were gradually stopped and two days later she was extubated. She was discharged home on 10th day of admission.

Three years later, patient is doing well and chest pain free! This was my first Primary PCI in CMS-TH and I still remember patient's family member saying 'YOU ARE GREAT DOCTOR'!

Final note:

Although the treatment of acute MI and chronic heart failure has improved considerably over the last 40 years, the in-hospital mortality of patients in cardiogenic shock complicating acute MI remains extremely high, even with early interventional therapy and has not changed in recent decades. Given that the SHOCK trial, using a strategy of early revascularization, has demonstrated statistical improvement in long-term outcomes, the current focus for the management of such patients who presented in shock should remain on timely reperfusion.