Primary angioplasty in acute myocardial infarction.

What is primary angioplasty in acute myocardial infarction?

Primary angioplasty is the treatment of choice for acute myocardial infarction in hospitals with experienced staff and modern facilities.

Myocardial infarction is a cardiac emergency that requires immediate treatment. When symptomatic, the patient experiences a sharp chest pain that lasts for more than half an hour. The pain may be reflected in other parts of the body, such as the arms, back, abdomen and neck.

Acute myocardial infarction is treated in two ways:

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• Thrombolysis. Thrombolysis is a medical method that involves the administration of strong drugs to reperfuse the heart muscle.
• Primary angioplasty. Angioplasty is an invasive method in which the doctor opens the vessel where the clot is located with the help of a catheter. 

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This type of angioplasty is called primary angioplasty.

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Features of primary angioplasty

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According to international studies, primary angioplasty has higher success rates than thrombolysis for the following reasons:

• There is a greater chance of the artery responsible for acute myocardial infarction opening
• There is less chance of restenosis of the artery
• There is less chance of complications, such as bleeding

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To increase the success rates of primary angioplasty, certain conditions must be met:

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• Quick and early diagnosis of acute myocardial infarction
• Quick transfer of the patient to a special cardiology unit
• Subjecting the patient to coronary angiography to identify the exact site of the obstruction 

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We get the best result when the time from the arrival of the patient to the opening of the artery does not exceed 90 minutes.

The aim is to save the myocardium from further ischemia and necrosis in order to reduce in-hospital mortality and the rate of heart failure. 

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How is angioplasty done?

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Step 1

Initially, after anaesthesia, the catheter is inserted up to the narrowed coronary artery that is responsible for the acute myocardial infarction.

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Step 2

Next, a guide wire is advanced into the stenosis and then the catheter with a special balloon at its end, which is inflated with fluid once it reaches the site of the stenosis. Thus, we have the opening of the narrowed artery. In many cases it is necessary to aspirate the clot with a special device before the balloon is inserted.

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Step 3

After the balloon catheter is withdrawn, another balloon catheter is advanced, which has a compressed metal mesh wrapped on its surface (stent). As the balloon is dilated, the stent expands, which remains at the site of the lesion after the balloon is removed and keeps the vessel lumen open. 

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Experience of the Clinic "St. Lucas" 

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At "Agios Loukas" we have all the modern facilities that, in combination with the qualified and experienced medical and nursing staff, make primary angioplasty a routine operation. Many times, patients with acute myocardial infarction experience hemodynamic disturbance - cardiogenic shock. In this case, there is the possibility of placing a special supportive pump in the heart, called an intra-aortic bag - IABP. Finally, more rarely, there is the possibility of complete mechanical assistance of the heart with an ECMO device.

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Dr. Peter Dardas,

Interventional Cardiologist

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