Primary PCI is the preferred emergency treatment for ST elevation myocardial infarction (STEMI), outperforming thrombolysis with over 90% effectiveness compared to 40-60%. The mortality benefits from primary PCI are primarily due to its superior ability to open blocked arteries rather than the removal of underlying stenosis. Key considerations for successful primary PCI include optimizing prehospital and in-hospital management, adopting a radial access approach, and using drug-eluting stents.

1. PRIMARY PCI
(Percutaneous Coronary Intervention)
Amir Aziz AlkatiriAmir Aziz Alkatiri
RS Awal Bros Pekanbaru

2. Primary PCI
Treatment of
choice for Acute MI

3. Definition
• Primary PCI : an emergent
percutaneous catheter intervention
in the setting of STEMI, without
previous fibrinolytic treatment
• is the preferred reperfusion strategy
in patients with STEMI

8. Primary PCI vs Thrombolytic

9. Primary PCI vs Thrombolysis
• Thrombolysis is effective in 40–60% of patients,
while p-PCI is effective in > 90%.
• Thus,comparing thrombolysis vs primary PCI is
comparing a semi-effective therapy vs a fully
effective therapy.
• The mortality benefit derived from the primary
PCI strategy is not related to the fact that the
underlying stenosis is removed.
• The mortality benefit of primary PCI is caused by
the simple fact that primary PCI is twice as
effective as thrombolysis in opening the artery.
European Heart Journal (2010) 31, 634–636

11. Components of delay in STEMI
European Heart Journal (2012) 33, 2569–2619

12. How to Optimize Reperfusion in Acute MI
ProblemProblem SolutionSolution
Longer Delay for
Presentation
(symptom onset to presentation)
Longer Delay for
Presentation
(symptom onset to presentation)
Large Media
Education
Large Media
Education
Delay for TransportationDelay for Transportation Logistical
Protocols
Logistical
Protocols
Delay for Treatment
(either lytics or PCI)
Delay for Treatment
(either lytics or PCI)
In-Hospital
Quality of
Care
In-Hospital
Quality of
Care

13. Prehospital and in-hospital management, and
reperfusion strategies within 24 h of FMC

14. Primary PCI: indications and procedural aspects

15. Procedural aspects
• Radial approach is preferred
• Drug-eluting stents (DES) reduce the risk of
repeated target vessel revascularization,
compared with bare-metal stents (BMS)
• Thrombus Aspiration during Primary PCI
showed improvement in indices of
myocardial reperfusion (ST-segment
resolution and myocardial blush) from
routine use of manual thrombus aspiration
before a balloon or a stent is introduced into
the coronary artery

16. Slender Club Japan
2009.12.04

17. Periprocedural pharmacotherapy
• DAPT : Aspirin 160-300mg +
ADP receptor blocker
(Clopidogrel/Prasugrel/Ticagrelor)
• Heparin
• GPIIB/IIIA inhibitor

19. Revascularization strategy for STEMI
with multivessel disease
• Still debatable
• Conservative approach
• Stage revascularization approach

20. Contoh Kasus
• Tn.D, 71thn
• Sakit dada berat sejak 6 jam SMRS disertai
keringat dingin
• Fakto Risiko: DM, Dislipidemia, Hipertensi
• TD 140/70, HR 60x/m
• EKG: SR, ST elevasi II,III,aVF, V5-V9
• Diagnosis: Acute Inferoposterior MCI