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