Primary PCI (percutaneous coronary intervention) is the use of emergency coronary angioplasty as the first-line treatment for a STEMI (ST-elevation myocardial infarction), the most serious form of heart attack. Rather than using clot-dissolving drugs (thrombolysis), the blocked coronary artery is opened mechanically by threading a catheter to the site of the blockage and inflating a balloon to compress the clot and plaque, followed by inserting a stent to keep the artery open.
Primary PCI is performed in a specialist cardiac catheterisation laboratory as an emergency procedure, 24 hours a day, 7 days a week. In the UK, most people with STEMI are taken directly from the ambulance to the cath lab, bypassing the emergency department. The key performance metric is ‘door-to-balloon time’ (the time from hospital arrival to balloon inflation), which should ideally be under 60 minutes. Every minute of delay results in additional loss of heart muscle.
Primary PCI is highly effective at restoring blood flow and limiting myocardial damage. Compared to thrombolysis, it produces better outcomes including lower mortality, lower risk of re-infarction, and lower risk of stroke. It is the preferred reperfusion strategy for STEMI in the UK where a primary PCI centre can be reached within 120 minutes of first medical contact.
In cases of spontaneous coronary artery dissection (SCAD), where a tear in the artery wall rather than a plaque rupture is the cause of the blockage, primary PCI may worsen the dissection and conservative management is often preferred instead. For cardiac arrest survivors where a heart attack is identified as the cause, primary PCI is typically performed immediately after resuscitation as part of the post-cardiac arrest care pathway.
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