“Angioplasty is available in only about 36% of centers even in the developed countries like the USA. In India too, less than 1% of people who have heart attack actually get an angioplasty. In such a situation, thrombolysis is a viable alternative to dissolve the clot using medicine,” Dr. Sandeep Bansal, Head of Department of Cardiology, Safdarjung Hospital, New Delhi. “Pharmacoinvasive therapy is a combination of thrombolytic medicine followed by a stenting procedure within the next 24 hours. And that covers for most problems of late presentation due to long distances or traffic in India.” “As far as the primary prevention of coronary artery disease is concerned, risk factor management makes a lot of economic sense because every one rupee spent on prevention of the disease saves six rupees on its treatment.” “Diabetes, blood pressure, and bad cholesterol are three major factors which contribute to more than 80% of heart attacks or coronary artery disease. If one has a healthy lifestyle, there is no need for costly tests or procedures like angiogram.”

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Complete Transcript:

Dr. Sandeep Bansal My talk has been on the rule of thrombolytic therapy in patients of myocardial infarction, i.e., the acute heart attacks. We all know and throughout the presentations throughout the entire sessions we have known that doing an angioplasty or opening up the vessel with the help of a balloon and putting in a stent is the best way to go about in treating acute heart attacks or myocardial infarctions, but there are severe limitations to this particular procedure. The first and the most important is the availability of this procedure. We all know that angioplasty as a procedure at the present time is available in only about 36% of centers even in the developed countries like the United States of America. In our own country, such facilities are available in much less number and round the clock catheterization lab facilities which are a prerequisite for doing primary angioplasty or treating heart attacks with a stent are even less. The current data show that less than 1% of people who have heart attack actually get to have angioplasty. The much better and possibly the way out in our country, in our patients, is to do a thrombolysis that is dissolve the clot using medicine and follow it up with an angioplasty or putting in a stent, what is known as pharmacoinvasive therapy. We have known that thrombolysis or clot busting the clot which blocks the coronary arteries and leads to a myocardial infarction is the way to go about in majority of the patients. One has known its advantage of not doing anything but consistently the studies have shown that just opening up using a thrombolytic therapy is inferior as compared to putting in a stent, so the combined therapy of giving a thrombolytic medicine and following it up with a stent within the next say three to 24 hours that is the best way to go about that covers for most of the aspects that are a problem in our country. For example, transportation, patients reporting late, so lot of precious time is lost and so we can have more number of patients get the benefit of therapy if we use thrombolytic therapy followed by doing an angioplasty. As far as the general precautions in our patients are concerned, I firmly believe that in India the risk factor management as anywhere in the world in fact, the risk factor management is the best way to go about in primary prevention of coronary artery disease and even heart attacks. We all know that diabetes, blood pressure, and bad cholesterol-these are three important factors which are important risk factors and together they constitute, you know they contribute to more than 80% of heart attacks or coronary artery disease that takes place. So if we control our blood pressure, if we control our lipids and if we control, i.e., we control our cholesterol and if we control our blood sugar that is the way to go about in managing ourselves and preventing the heart attacks. Thereafter, we do not need any tests, we do not need any treadmill test. People come and ask me, “Do I need to undergo a CT coronary angiography?” “D I need to undergo…?” There are a plethora of tests that are available but if you manage your basics, if you do regular physical activity, if you control your blood sugar and eat a healthy diet and you keep your stress levels down with the help of noninvasive methods like yoga and self control, that is the way to go about. You do not really need any costly tests for preventing the coronary artery disease and preventing the acute heart attacks. Another very important thing is that it is said that a stitch in time saves 9 and prevention is always better than cure. This now actually makes a lot of economic sense also because it is now known that for every one rupee which is spent on prevention actually saves six rupees in terms of treatment of the disease and for a country like ours, prevention therefore is the only way to go about. In the end, I would like to conclude by saying that if we prevent our risk factors, or I should say, if we control our risk factors in a proper way, we do not need any tests and we would actually be able to decrease the chances of heart attack by a very significant amount.


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