Emergency Angioplasty (Primary PCI) in Ahmedabad

Emergency angioplasty opens the artery responsible for a heart attack, with the aim of restoring blood flow and limiting damage to the heart muscle. When performed without prior clot-dissolving treatment, it is called primary percutaneous coronary intervention, or primary PCI.

Hearing that you or a loved one needs emergency angioplasty can be frightening. There may be little time to take everything in. Understanding why the team is acting quickly, what the procedure involves and what happens afterward can help you follow the decisions being made.

Dr. Kulin Sheth performs primary PCI at Apollo CVHF Hospital, Bodakdev, Ahmedabad, as part of the hospital's emergency and cardiac-care teams.

Possible symptoms include:

• Pressure, heaviness, squeezing, tightness or pain in the chest, sometimes spreading to an arm, the jaw, neck, back or upper abdomen.
• Breathlessness, with or without chest discomfort.
• Cold sweating, nausea, vomiting, dizziness or fainting.
• Unusual weakness or fatigue, particularly when accompanied by other symptoms.
• Discomfort that persists, comes and goes, or returns after briefly improving.

“Gas hoga?” is an understandable thought when symptoms resemble indigestion. Unfortunately, symptoms alone cannot reliably distinguish acidity from a heart attack. Do not wait for an antacid to work before seeking help for concerning symptoms.

Chest discomfort is common in both men and women. Some people, including older adults and people with diabetes, may have breathlessness, weakness or other symptoms without obvious chest pain. You do not need to have every symptom to need urgent assessment.

The Chest Pain & Heart Attack page explains symptom assessment and why an initial test may not provide the complete answer.

Primary PCI is principally used for a ST-elevation myocardial infarction, or STEMI: a heart attack with ECG findings that usually signal an artery needs to be opened immediately. Some other ECG patterns and clinical situations also require an emergency approach.

A non-ST-elevation myocardial infarction, or NSTEMI, does not have the same persistent ST-elevation pattern. It can still be serious. Continuing chest pain, shock, dangerous heart rhythms or other signs of instability may require immediate angiography. In more stable patients, the timing depends on the overall risk assessment.

These terms describe clinical findings, not simply a “major” or “minor” heart attack. Not every heart attack requires the same procedure at the same time.

The team considers the symptoms, ECG, blood tests, circulation and likely cause of the problem. An elevated troponin alone does not automatically mean a patient needs a stent.

When an artery stops supplying enough blood, the heart muscle it feeds is at risk. Earlier appropriate treatment offers a better opportunity to preserve that muscle. Primary PCI is therefore an emergency procedure rather than a scheduled angioplasty.

The pain has reduced. Is it safe to wait?

No. Symptoms can fluctuate even while the problem remains serious. Improvement does not reliably show that blood flow is adequate or that the danger has passed.

What if several hours have already passed?

Seek emergency assessment anyway. Being late does not mean there is no useful treatment. Continuing symptoms, heart failure, shock or dangerous rhythms may still make intervention urgent. The decision depends on the patient's current condition and findings, not only the time on the clock.

What if the patient is already at another hospital?

Tell the treating team that you would like to understand the treatment and transfer plan. They can assess whether transfer is needed and arrange the safest appropriate route. Do not take an unstable patient out of hospital in a private vehicle to seek a preferred doctor.

Assessment and treatment often happen in parallel. The emergency team checks symptoms, blood pressure, heart rhythm and oxygen levels, and obtains an ECG promptly. Blood samples are taken, including high-sensitivity troponin where available. Further tests, such as an echocardiogram, are used when they help guide care.

A single normal early troponin does not reliably exclude a heart attack. Serial troponin testing, interpreted alongside symptom timing and the clinical findings, may be required. Repeat ECGs may also be needed if the first tracing is inconclusive or symptoms continue.

However, when the symptoms and ECG clearly indicate a heart attack requiring immediate artery-opening treatment, the team should not wait for troponin results before proceeding. Tests must help the decision without creating an unsafe delay.

Medicines to limit clotting and other treatment are given according to the patient's condition. The team explains the proposed procedure and important risks as circumstances allow.

For families, useful information includes when symptoms began, current medicines, allergies, previous bleeding or stroke, kidney problems and earlier heart procedures. Share reports that are readily available, but do not delay care to collect paperwork.

The procedure takes place in a catheterisation laboratory, often called the cath lab.

1. An artery is accessed at the wrist or groin. Local anaesthetic numbs the area. Wrist access is generally preferred when suitable, while groin access may be appropriate for particular clinical needs.
2. Coronary angiography identifies the problem. Thin tubes called catheters and X-ray contrast show the heart arteries and help identify the artery responsible for the attack.
3. The blockage is treated. A fine wire is passed across the affected segment. Balloons and, where needed, a stent are used to improve blood flow.
4. The result is assessed. The team checks the treated artery, blood flow and the patient's condition before completing the procedure.

A stent is a small mesh scaffold that supports the artery from inside. It is used when appropriate; the decision depends on what the angiogram shows.

Many patients remain awake with local anaesthetic and medicines for comfort when needed. Tell the team about pain, breathlessness or anxiety during treatment. Patients who are critically unwell may need additional support, including anaesthesia or breathing support.

Angioplasty usually does not involve opening the chest. It differs from bypass surgery. The coronary angiography and angioplasty and stenting pages explain these procedures in more detail.

The aim is to restore blood flow promptly using the safest suitable strategy. If transfer for primary PCI would take too long, some patients with a recent STEMI may be offered fibrinolysis, a medicine that dissolves the clot, after checking for contraindications and bleeding risk.

This is not suitable for every patient or every type of heart attack. The choice depends on symptom timing, expected treatment delay and the individual risks.

Clot-dissolving treatment is usually followed by transfer to a PCI-capable hospital and planned angiography. If it has not restored blood flow, or the patient deteriorates, urgent rescue PCI may be needed. Angioplasty after clot-dissolving treatment is a different pathway from primary PCI.

Bypass surgery may be considered when the anatomy or clinical circumstances make PCI unsuitable, or when PCI cannot achieve the necessary result. The team decides the appropriate route for the situation.

The purpose of primary PCI is to restore blood flow, limit heart-muscle damage and improve the patient's prospects. The benefit depends on how quickly treatment occurs, the artery involved, the amount of damage already present and the patient's overall condition.

Opening the main artery does not guarantee complete recovery. Sometimes blood flow through the smaller vessels remains impaired, or the heart muscle has already sustained substantial injury.

Important risks include bleeding, injury to blood vessels or the coronary artery, a contrast reaction, kidney injury, dangerous heart rhythms, stroke, further heart damage and, in severe cases, death. A clot can also form within a stent. These risks vary considerably between patients and must be weighed against the danger of leaving the heart attack untreated.

Why was only one blockage treated?

The artery causing the heart attack is the immediate priority. Other significant blockages may be treated during the same procedure, later in the admission or in a planned staged procedure. In some cases, bypass surgery or medical treatment is more appropriate.

Leaving another blockage for later does not necessarily mean treatment is incomplete or that it has been overlooked. The decision considers the patient's stability, artery anatomy, kidney function and the benefits and risks of further treatment.

If the heart attack causes cardiogenic shock, the heart cannot pump enough blood to support the body's organs. Emergency treatment of the responsible artery is crucial, but routinely stenting all other arteries at that time is generally avoided. Additional circulatory support is considered selectively, rather than being required for everyone.

“Have shu karvu?” is often the family's next question.

The immediate focus is monitoring the heart and supporting recovery. The care team watches for recurrent symptoms, rhythm problems, heart failure, bleeding and changes in kidney function.

An echocardiogram helps assess the heart's pumping function and possible complications. Some patients need coronary-care or intensive-care monitoring. The length of stay depends on the heart attack and recovery, rather than on the stent alone.

Medicines after a heart attack

Treatment commonly includes:

• Antiplatelet medicines: often aspirin with a second antiplatelet to reduce the risk of further clots, including a clot within a stent. Twelve months is a common default after an acute coronary syndrome when bleeding risk is not high, but the drugs and duration are individualised. Plans differ when bleeding risk is higher or an anticoagulant is also needed.
• Cholesterol-lowering treatment: usually a high-intensity statin, with additional treatment when appropriate. Follow-up blood tests help assess the response and guide an individual LDL-cholesterol target.
• Other heart medicines: selected according to heart function, blood pressure, symptoms, kidney function and other conditions.

Do not stop prescribed antiplatelet medicines on your own, even if you feel well. If bleeding occurs or surgery or dental treatment is planned, contact the treating team promptly so that a safe plan can be made. Major bleeding requires emergency care.

Recovery, activity and rehabilitation

A successful stent treats a particular artery. Ongoing care for coronary artery disease remains important.

Cardiac rehabilitation combines a tailored activity programme with education, risk-factor management and emotional support. Ask about a suitable supervised or home-based programme.

Walking, exercise, work, driving, travel and sexual activity should be resumed according to your recovery and clinical assessment. A person who has had a heart attack may need a different plan from someone who has had an uncomplicated planned angioplasty.

Feeling tired, worried or afraid of another attack can be part of recovery. Tell the team how you are coping; persistent anxiety or low mood deserves attention too.

Before discharge, make sure you understand your medicine schedule, wrist or groin wound care, follow-up arrangements and what to do if symptoms return. The recovery and follow-up page provides further guidance.

Seek emergency care for:

• New or recurrent chest pressure or pain, especially with sweating, nausea or breathlessness.
• Severe or rapidly worsening breathlessness, collapse or fainting.
• A rapid or irregular heartbeat accompanied by chest discomfort, marked weakness or dizziness.
• Significant bleeding, bleeding from the access site that does not stop with firm pressure, or rapidly increasing swelling.
• A cold, pale, numb or severely painful hand or leg on the side used for the procedure.
• Sudden weakness on one side, facial drooping or difficulty speaking.

Do not assume new chest pain is simply part of recovery. Do not drive yourself or wait for a routine follow-up.

Increasing wound redness, discharge, fever or less urgent medicine-related concerns should also be reported promptly to the treating team.

Once the immediate emergency has been treated and the patient is stable, you may want a clearer understanding of the angiography findings, the treatment performed or the plan for remaining blockages. That is a reasonable conversation to have.

Dr. Kulin Sheth personally reviews existing reports and angiography images when providing a second opinion before deciding whether any additional assessment is appropriate. The review can address a proposed staged angioplasty or bypass operation, heart function, medicines and recovery.

Bring the discharge summary, angiography images, procedure report, ECGs, echocardiogram and current medicine list if available. The aim is to help you understand the reasoning and options in your situation.

A second opinion must not delay treatment for an active heart attack or new emergency symptoms. If the patient is still unwell in hospital, discuss questions with the treating team immediately and let them coordinate any necessary specialist review.

References

• 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes
• American Heart Association: Key recommendations from the 2025 acute coronary syndromes guideline
• 2023 ESC Guidelines for the Management of Acute Coronary Syndromes
• Fifth Universal Definition of Myocardial Infarction, 2026
• American Heart Association: Patient messages from the 2025 acute coronary syndromes guideline
• NHS: How coronary angioplasty and stent insertion are performed
• Guy's and St Thomas' NHS Foundation Trust: Coronary angioplasty and its risks
• NHS: Recovery after coronary angioplasty and stent insertion
• American Heart Association: What cardiac rehabilitation involves
• American Heart Association: Life after a heart attack