Islamabad: If you are a resident of Islamabad and having a heart attack after sunset, don’t go to the Pakistan Institute of Medical Sciences (PIMS) or any other public hospital—because they don’t perform Primary PCI or ‘angioplasty in emergency’ after dark.
Primary Percutaneous Coronary Intervention (PCI) is a time-sensitive procedure used to reopen blocked arteries during a major heart attack, technically known as a myocardial infarction (MI). It involves inserting a balloon-tipped catheter into the coronary arteries and, in most cases, placing a stent to restore blood flow.
Renowned interventional cardiologist Prof. Khawar Kazmi explained that the first hour from the onset of a heart attack is called the “golden hour,” as restoring blood supply within this window can often prevent any damage to the heart.
“Primary angioplasty within four hours of the onset of a heart attack is still considered beneficial and can limit the extent of heart damage,” he noted.
On average, 25 to 30 people in Islamabad suffer major heart attacks each day. But fewer than a dozen reach the PIMS Cardiac Centre—and only during daylight hours.
Despite serving a population of over three million, and routinely receiving patients from Punjab, Khyber Pakhtunkhwa, and Kashmir, PIMS does not offer Primary PCI services after sunset.
Officials say PIMS’s cardiac unit is equipped with three catheterization machines, but one remains out of order due to a minor technical fault. Although still under warranty, it has not been repaired.
Of the two remaining machines, only one is used for interventional cardiology, meaning it must handle both scheduled and emergency angioplasties. Officials insist the hospital has enough trained cardiologists to run both machines if they were operational.
Dr. Shafiq Ahmed, head of the PIMS Cardiac Centre, said the primary barrier to offering night-time angioplasty is a lack of trained support staff.
“We have qualified cardiologists available, but we lack the trained cathlab technicians and support personnel needed to perform angioplasties after hours,” he told this scribe. “If the required manpower is arranged, and equipment is provided, we can certainly consider starting Primary PCI service at night.”
He added that a formal proposal for round-the-clock Primary PCI has been submitted to the hospital administration, though no decision has yet been taken.
Former Chief Executive Officer of the Islamabad Healthcare Regulatory Authority (IHRA), Dr. Quaid Saeed, who began licensing hospitals with cath labs in the capital, confirmed that public sector hospitals lack trained emergency staff to promptly diagnose heart attacks and do not offer Primary PCI after dark.
Following directives from the Supreme Court of Pakistan, he said IHRA developed a strict checklist and inspected all private hospitals’ cath labs, some of which were found to be “five-star” in terms of infrastructure. However, he added, PIMS could not be inspected.
Dr. Quaid Saeed, who resigned from IHRA following board-level interventions into IHRA affairs, stressed that angioplasty must be performed immediately after a heart attack to save lives.
“Only a few private hospitals in the capital offer 24/7 Primary PCI, but they charge exorbitantly—beyond the reach of most patients,” he said.
Medical experts warn that heart attacks frequently occur at night or in the early morning hours, and any delay in treatment can result in irreversible damage or death.
According to the Pakistan Cardiac Society, an estimated 250,000 people die of heart attacks each year in Pakistan, with lack of timely access to emergency angioplasty being a key contributing factor.
At present, only two public facilities in the Islamabad–Rawalpindi region are believed to offer Primary PCI services after hours: the Armed Forces Institute of Cardiology (AFIC) and the Rawalpindi Institute of Cardiology (RIC), though even some specialists remain uncertain whether RIC provides uninterrupted round-the-clock coverage.
Despite Islamabad’s status as the nation’s capital, its public hospitals lack the capacity to offer critical cardiac intervention when it is most needed—after dark. For many heart attack patients, the cathlab closes—but the clock does not.
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