Peripheral Centre Primary PCI: Bridging the Acute Myocardial Infarction Care Gap

Background Acute myocardial infarction (AMI) continues to be a major cause of morbidity and mortality in India, especially in peripheral regions where access to advanced cardiac care is limited. Primary percutaneous coronary intervention (PPCI) is the preferred treatment for ST-elevation myocardial infarction (STEMI), yet its use in rural and semi-urban centers remains challenging due to delayed presentation and low public awareness. Methods This retrospective observational study enrolled 265 STEMI patients who underwent PPCI at a peripheral-centers in Gaya, Bihar, from November 2021 to March 2025. Patients presenting within 12 hours of chest pain onset with ECG-confirmed ST-elevation were included. Demographic data, risk factors, angiographic findings, procedural success, and 6-month outcomes were analyzed. Results The cohort was predominantly male (64%, n = 170) with a mean age of 54 ± 14 years. Diabetes (21.5%), hypertension (27.9%), obesity (35.8%), and tobacco use (19.6%) were the major risk factors. Premature CAD (< 40 years) occurred in 9.4%, strongly linked to smoking (p < 0.05). Seven percent reported significant psychosocial stress. LAD was the culprit artery in 45%, followed by RCA (36%) and LCX (19%). TIMI III flow was highest in RCA (90%) and lowest in LAD (65%), where slow flow correlated with high thrombus burden and LV dysfunction. In-hospital mortality was 4.5%, rising to 17.9% (n = 28) in cardiogenic shock. At 6 months, 70% showed an average LVEF improvement of 15 ± 8%. Complications included intracerebral hemorrhage (ICH; 1.1%), reinfarction (3%), and recurrent HFrEF admissions (7.9%). Conclusion PPCI in peripheral centers is practical and effective, offering outcomes comparable to urban facilities. Improving public awareness and pre-hospital systems could significantly enhance survival.