Clinical outcome of patients ST-segment elevation myocardial infarction (STEMI)

ST-segment elevation myocardial infarction (STEMI) is complete occlusion of a coronary artery leading to transmural ischemia within minutes or hours. The primary pathogenesis of this disease is the rupture of fatty deposits in the arteries. This is due to the fact that the body creates blood clots and platelets when fatty deposits in an artery rupture, resulting in complete occlusion of a coronary artery. Patients often experience dizziness or chest pain, and some may even experience sudden cardiac arrest. There is a 5–10% fatality rate associated with this medical life-threatening emergency. Since “every minute wasted may lead to myocardial ischemia”, STEMI must be treated with vasodilation as soon as possible.

Since 2017, the Heart Center of Bangkok Hospital Phuket has developed protocols and care for patients with coronary artery disease based on international guidelines to ensure that patients receive efficient treatment in a fast and timely manner. There are now two methods of vasodilation:

1. Fibrinolytic therapy
2. Percutaneous Coronary Intervention (PCI)

Percutaneous Coronary Intervention (PCI) is the most effective method currently available, with a success rate of 95%, compared to the 60-70% success rate of fibrinolytic therapy. Consequently, cardiac catheterization—which is primarily carried out through the forearm’s radial artery—has been employed by the Heart Centre of Bangkok Hospital Phuket as the first line treatment. Physicians and nurses strive to complete vasodilation as soon as possible, often against the clock. According to international standards, patients should have their coronary arteries vasodilated within 24 hours of onset of symptoms in a 2-plane cardiac catheterization lab with state-of-the-art equipment and a cardiac surgery team on hand to handle any complications that may arise during the procedure. 

The Heart Center of Bangkok Hospital Phuket has a team of cardiology specialists and staff ready to serve you 24 hours a day, 7 days a week. Angioplasty can be completed in less than 90 minutes after a patient arrives at the hospital thanks to a quick, precise diagnosis and a smooth patient admission process. Early angioplasty lowers risks, shortens hospital stays, and enhances patient quality of life.

At Bangkok Phuket Hospital, in 2023, percutaneous coronary intervention was performed on 87% of patients who arrived within 90 minutes after being diagnosed with ST-segment elevation myocardial infarction. This figure is impressive when compared to US hospitals in the 50^th percentile, where 72.5% of patients underwent percutaneous coronary intervention (PCI) within 90 minutes of hospital admission.

Percutaneous Coronary Intervention (PCI) 

Cardiac catheterization is a common procedure used for diagnosis and treatment of various heart diseases. In this procedure, the physician inserts a small catheter into an artery or vein in the groin, wrist, arm, or neck. After being carefully inserted, the catheter is advanced to the heart via the artery. Traditionally, cardiac catheterization was usually performed on the femoral artery in the groin. Due to its large size, femoral artery can easily be inserted with a catheter and only needle-sized incision is left on the patient’s groin. To lessen the possibility of bleeding, the patient must, however, lie down and refrain from bending their leg on the operation site for between two to six hours following the procedure. Therefore, in an attempt to lessen this problem, cardiologists have attempted to do this technique at a different location—transradial catheterization. 

Advantages of transradial catheterization 

1. Minimize major side effects following femoral artery catheterization 
2. Reduce the length of hospital stay. After the procedure, patients can get up and move around right away.  
3. Fewer local complications in comparison to femoral artery catheterization. This is because it is simpler to halt bleeding because the femoral artery is smaller and located closer to the skin surface. Blood transfusion may be required if there is femoral arterial bleeding. Moreover, it can occasionally result in an aneurysm that needs to be surgically repaired and causes recovery delays for leg bending and standing and walking.  

*Reference 

ACC-NCDR Registry. Percentage of STEMI patients receiving Primary PCI with In 90 minutes. A Data Form The NCDR Chest Pain-MI Registry. J Am Coll Cardiol [Internet]. 2023 [cited 2023 May 17]. Available from: https://cvquality.acc.org/NCDR-Home/registries/hospital-registries/chest-pain-mi-registry