PRIMARY PCI

(Percutaneous Coronary Intervention)

Amir Aziz Alkatiri

Amir Aziz Alkatiri
RS Awal Bros Pekanbaru
Primary PCI
Treatment of
choice for Acute MI
Definition

• Primary PCI : an emergent

percutaneous catheter intervention
in the setting of STEMI, without
previous fibrinolytic treatment
• is the preferred reperfusion strategy
in patients with STEMI
Primary PCI vs Thrombolytic
 Primary PCI vs Thrombolysis

• Thrombolysis is effective in 40–60% of patients,

while p-PCI is effective in > 90%.
• Thus,comparing thrombolysis vs primary PCI is
comparing a semi-effective therapy vs a fully
effective therapy.
• The mortality benefit derived from the primary
PCI strategy is not related to the fact that the
underlying stenosis is removed.
• The mortality benefit of primary PCI is caused by
the simple fact that primary PCI is twice as
effective as thrombolysis in opening the artery.

European Heart Journal (2010) 31, 634–636

Components of delay in STEMI

European Heart Journal (2012) 33, 2569–2619

How to Optimize Reperfusion in Acute MI

Problem Solution

Longer Delay for Large Media

Presentation Education
(symptom onset to presentation)

Delay for Transportation Logistical

Protocols

In-Hospital
Delay for Treatment Quality of
(either lytics or PCI)
Care
Prehospital and in-hospital management, and
reperfusion strategies within 24 h of FMC
Primary PCI: indications and procedural aspects
 Procedural aspects
• Radial approach is preferred
• Drug-eluting stents (DES) reduce the risk of
repeated target vessel revascularization,
compared with bare-metal stents (BMS)
• Thrombus Aspiration during Primary PCI
showed improvement in indices of
myocardial reperfusion (ST-segment
resolution and myocardial blush) from
routine use of manual thrombus aspiration
before a balloon or a stent is introduced into
the coronary artery
 2009.12.04

Slender Club Japan

 Periprocedural pharmacotherapy
• DAPT : Aspirin 160-300mg +
ADP receptor blocker
(Clopidogrel/Prasugrel/Ticagrelor)
• Heparin
• GPIIB/IIIA inhibitor
 Revascularization strategy for STEMI
with multivessel disease
• Still debatable
• Conservative approach
• Stage revascularization approach
Contoh Kasus

• Tn.D, 71thn
• Sakit dada berat sejak 6 jam SMRS disertai
keringat dingin
• Fakto Risiko: DM, Dislipidemia, Hipertensi
• TD 140/70, HR 60x/m
• EKG: SR, ST elevasi II,III,aVF, V5-V9

• Diagnosis: Acute Inferoposterior MCI