Post on 03-Mar-2018
Acute Myocardial Infarction in India
DR. PRAVEEN CHANDRA
MD,DM,FACC,FSCAI,FESC
Chairman – Division of Intervention Cardiology
Medanta – The Medicity, INDIA
Coronary Heart Disease in India
29.8 million coronary heart disease patients in India.1
1.27 million acute coronary events
20,000 coronary bypass surgeries and 1,113,359 coronary angioplasties /year 2
1.Gupta R ,International Journal of Cardiology 2006(108) 291 – 300
2.NIC PTCA REGISTRY :Update 2009
ACS in India:
Patients are younger and with higher mortality
India ACS registry - CREATE, Xavier et al Lancet 2008; 371: 1435–42
Treatment Options
• Pre-hospital
• Pharmaco-invasiveFibrinolytics
• POBA / ? DEB
•BMS / DESPAMI
►DEB : In AMI
►Current Practice & Future Perspective
Medanta data with Dior
• Total number of patients = 115
• Total number of Dior = 128
• Bifurcation = 48
• ISR = 14
• Small vessels = 51
• Diffuse disease = 15
• Procedural success = 113 ( 88.3%)
• Stenting needed (Bailout) = 15( 11.7%)
• 1 month MACE
• 0
• Completion of 6 months clinical FU
• 62 ( 56.36% )
• Symptomatic after 6 months
• 5 ( 8.06%)
Case Scenario 1 - AWMI
RCA Normal LAD culprit vessel
POBA with smaller balloon Post POBA
DEB Inflated Excellent final result
Case Scenario 2 - ALMI
Diagonal ostium : culprit lesion
Predilatation with smaller balloon
Case Scenario 3 - AL MI
Diaganol 1 culprit vesselPOBA with DEB post dilatation with smaller balloon
Post DEB , final result
Case Scenario 4 - IWMI
PLB , the culprit vessel
POBA with smaller balloon DEB Inflated
Case Scenario 4 - PWMI
OM I : culprit vessel DEB Inflated
Bailout stenting due to dissection - BMS
Role of DEB in AMI in Indian Context
►MI at young age
Avoid STENTS as far as possible
►Diffuse nature of disease
Spot stenting – BMS+DEB
►Small vessels
DEB – bailout stenting with BMS
►Elderly patients
Take Home Message
►Current role of DEB
ISR
Ostial lesions
Bifurcation lesions
Small vessels
C/I to DAT
►Future perspective
ACS
►Local plaque stabilisation
►Avoid late malapposition due to DES