# Common Myths and Misconceptions About Primary Angioplasty in Acute Myocardial Infarction: An Evidence-Based Perspective for Indian Primary Care Physicians

## TL;DR

This paper addresses myths about primary angioplasty for heart attacks in India and highlights the need for better education and systems to improve patient outcomes.

## Contribution

The paper provides an evidence-based analysis of misconceptions about primary PCI among Indian primary care physicians.

## Key findings

- Primary PCI is safer and more effective than thrombolysis for STEMI patients.
- Pharmacoinvasive strategies offer comparable outcomes in resource-limited settings.
- Many Indian STEMI patients still do not receive timely primary PCI due to misconceptions.

## Abstract

Primary percutaneous coronary intervention (PCI) is the gold standard for managing ST-elevation myocardial infarction (STEMI). However, in India, despite the availability of catheterization laboratories, timely access to PCI remains limited due to persistent myths and misconceptions among primary care physicians. Common misconceptions include exaggerated concerns about procedural risks, the belief that medical management or thrombolysis is equally effective, the assumption that patients must be fully stabilized before referral, and uncertainty regarding the role of pharmacoinvasive (PI) strategies. Evidence consistently demonstrates that primary PCI is both safe and highly effective, reducing mortality, reinfarction, and stroke compared with thrombolysis, with very low complication rates. Despite these proven benefits, only a small proportion of STEMI patients in India currently receive primary PCI. Significant delays in care also persist, with many patients reaching the hospital several hours after symptom onset. PI therapy has emerged as a pragmatic alternative when timely PCI cannot be achieved, offering outcomes comparable to primary PCI in resource-limited and geographically constrained settings. Addressing these misconceptions through targeted education, standardized protocols, and strengthened STEMI networks is essential to improve outcomes and optimize reperfusion therapy in India.