PRIMARY PCI IN STEMI CHALLENGES AND INNOVATIONS IN RESOURCE -LIMITED SETTINGS OF BALOCHISTAN

Abstract

Background

A death by distance situation contributes to ST-Elevation Myocardial Infarction (STEMI) mortality in Balochistan. Although the gold standard of Primary PCI (PPCI) is used, geographical and infrastructural constraints make it necessary to implement alterations in protocols.

Objectives

 To assess clinical outcomes and 30-day mortality in 100 STEMI patients treated using PPCI as compared to pharmacoinvasive interventions in a resource-limited environment.

Place and duration of study: January 2025 to April 2025 Cardiology Department, Sandeman Provincial Hospital / Bolan Medical Complex Hospital, Quetta

Methodology

 This is a prospective study that was undertaken at the Sandeman Provincial Hospital / Bolan Medical Complex Hospital, Quetta, Quetta, and 100 patients were enrolled. The participants were divided into either immediate PPCI (urban) or pharmacoinvasive (drip-and-ship) (rural) cohorts. Evaluation of Door-to-Balloon (D2B) time, transracial success, and Major Adverse Cardiac Events (MACE) by SPSS.

Results

The mean age was $54.2 \pm 8.6$ years, reflecting early-onset CAD. While 62% of patients were rural referrals with First Medical Contact-to-Device times exceeding 240 minutes, local D2B times averaged $82 \pm 15$ minutes. PPCI achieved 94% procedural success. A significant difference was noted in 30-day MACE (4% for immediate PPCI vs. 9% for delayed; $p < 0.05$). Notably, the transracial approach significantly reduced bleeding complications ($p = 0.042$), proving vital for resource-limited recovery.

Conclusion

 In Balochistan, primary PCI can be done, but it needs a dual-track. The advantage of urban patients is that there is immediate intervention, and the survival of rural patients is based on the pharmacoinvasive model. The introduction of provincial "STEMI Network" and Tele-ECG triage and transracial methods is necessary to address the problem of logistical delays and provide equal cardiac care.