Primary Angioplasty in Acute Myocardial Infarction (PAMI)

August 30, 2021

Background

Myocardial infarction (heart attack) is a medical emergency that can occur suddenly without any warning signs. It is caused when blood flow to the heart gets obstructed due to clogged arteries. A clogged artery (usually due to the build-up of plaque, or blood clots) leads to a lack of blood flow and oxygen supply to the heart causing damage to the heart muscles.

According to the World Health Organization (WHO), about 17.9 million people across the globe die due to heart diseases every year. Heart attack and stroke accounts for 85% of these deaths. In India, heart diseases account for about 45% of the deaths in the age group 40-69 years of age.

Heart attacks though life-threatening and disabling can be averted if diagnosed and treated promptly.

What is primary angioplasty, and how is it performed?

Primary angioplasty (also known as percutaneous transluminal coronary angioplasty (PTCA), percutaneous coronary intervention, balloon angioplasty, etc.) is a minimally invasive, safe, and life-saving catheter-based procedure used to treat heart attack or acute myocardial infarction.

Percutaneous means ‘through the skin’, transluminal means ‘passing through a lumen or channel, angio means blood vessels, and plasty means opening up.

  • The procedure is done under local anaesthesia in a special hospital setting known as cardiac catheterization laboratory.
  • It involves passing a catheter through one of the peripheral arteries, either radial or femoral artery and engaging the coronary artery under X-ray guidance.
  • A contrast dye is then injected into the catheter to locate the block.
  • A small balloon fitted at the catheter tip is then carefully guided at the blockage site and inflated to reopen and restore blood flow.
  • After the block is removed, the balloon is deflated and removed along with the catheter.
  • Angioplasty is often followed by the placement of a permanent stent (a metal mesh), which helps to keep the artery open for a long period.

Benefits of a Coronary Angioplasty vs. Thrombolysis

Primary angioplasty is performed as an alternative to thrombolysis, which involves drugs to dissolve clots and reopen the artery. As compared with thrombolysis, primary coronary angioplasty results in:

  • Improvement of blood flow to heart, which increases survival chances
  • Immediate relief from the symptoms like chest pain, breathlessness, etc
  • Lower chances of stroke, heart failure, and non-fatal re-infarction in the future
  • Lower medical charges

Who needs Coronary Angioplasty?

  • Coronary angioplasty can be either done as an emergency procedure if a patient presents with a heart attack or as a planned procedure in diagnosed cases to prevent a future attack.
  • It is usually recommended when there is >70% blockage in the main blood vessel supplying the heart.
  • Angioplasty is often used to treat patients, in whom medications and lifestyle changes fail to relieve symptoms

However, it is important to remember that not all patients can be a candidate for coronary angioplasty. Your doctor will help you to choose the best treatment plan based on your coronary anatomy and health conditions.

Types of Coronary Angioplasty

  • Balloon Angioplasty: Plain balloon angioplasty is done to relieve symptoms in patients with a small artery where stents cannot be deployed or as a bail out procedure in a very sick patient to be followed by complete revascularization later. The procedure involves passing a special catheter attached to a tiny balloon through the coronary artery. The balloon is then inflated to widen the narrowed artery and restore blood flow to the heart.
  • Angioplasty with Stenting: In this technique, plain balloon angioplasty is followed by the placement of a stent to reduce re-narrowing of the arteries. Stents can be of 2 types
    • Bare-metal stents, which are made of metals
    • Drug-eluting stents, which are coated with medications that release slowly over time to prevent the artery from getting clogged again. Drug-eluting stents have better efficiency in preventing blockage as compared to bare-metal stents.

Frequently Asked Questions:

1. How to identify early signs of a heart attack?

Early signs of a heart attack may include discomfort or pain in the chest, lightheadedness, shortness of breath, pain in the arms, the back, neck, jaw, or stomach, etc. Do not ignore these signs and symptoms. Rush to your nearest hospital, preferably which has a catheterization lab for immediate medical attention, as the time taken to receive treatment is of paramount importance.

2. What can I expect after undergoing a coronary angioplasty?

After a coronary angioplasty procedure, you may be expected to stay for a day or two in the hospital. You will be able to return to your routine life within a week or less.

3. Is coronary angioplasty a major surgery?

No. Coronary angioplasty is a minimally invasive catheter-based procedure that involves smaller incisions and thereby offer speedy recovery, fewer chances of re-hospitalization, minimal scarring, and lower risk of complications as compared to open-heart bypass surgery.

4. How do I care for myself at home after angioplasty ?

At home, you may or may not experience some pain in the area of the incision, which is expected to go away with some time. You can walk for shorter distances and avoid going up and down the stairs frequently. Avoid strenuous activity. Contact your doctor immediately if you notice any bleeding or swelling around the incision area. Complete recovery may take a week. Make sure to include more fruits and vegetables in your diet, quit smoking and drinking alcohol, and exercise regularly. Consult your doctor before starting an exercise program.

5. What is the golden hour to receive treatment for a heart attack?

The golden hour is the first 60 minutes after a heart attack. If the artery is opened and the blood flow is established within this golden hour, heart muscles recover completely.

6. How much does an angioplasty cost in India?

The cost of an uncomplicated angioplasty with a stent would be approximately Rs. 2.5 lakhs.

- By Dr. Karthik V, Senior Consultant, Interventional Cardiology, Columbia Asia Hospital – Hebbal (A unit of Manipal Hospitals).

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