Stemi India, a not-for-profit national organization, is now focused on improving the ST-elevation myocardial infarction (Stemi), a life threatening medical emergency that results from a sudden and occlusive thrombus in the coronary artery in India.

The NGO is now gearing up to review scientific literature, educate and train Stemi teams in hospitals, develop Stemi guidelines and systems of care approaches relevant for India.

It has also released a data from CREATE, a large clinical registry of acute coronary syndrome patients from 89 large hospitals in 10 regions and cities across India conducted by the Kovai Erode Pilot which is a  Stemi initiative.

A recent paper was published in the British Heart Journal ‘Systems of care for ST-elevation myocardial infarction in India: is it time’ highlights the need to develop a system of care for Stemi or heart attack in India. The paper is authored by Dr.  Thomas Alexander from Kovai Medical Centre and Hospital, Coimbatore, Sameer Mehta University of Miami, Miami, Florida, USA, Ajit Mullasari , Madras Medical Mission, Chennai, and Brahmajee K Nallamothu, University of Michigan Medical School, Ann Arbor, Michigan.

The data revealed of the  20 000 patients enrolled in CREATE trial,  over 60 per cent had Stemi, which was substantially higher than in North American and European registries. These patients young and from the  lower socioeconomic status when compared with non- Stemi patients. The median time from the onset of symptoms to hospital arrival was 300 minutes  in STEMI patients, which was  more than double the delay reported in developed countries. Approximately 60 per cent received fibrinolytic therapy and only 8 per cent underwent percutaneous coronary intervention (PCI) during their hospitalization, suggesting substantial room for improvement in the use of acute reperfusion therapy.

Dr. Thomas Alexander stated that India needs to focus on non-communicable diseases, particularly conditions like Stemi which affects young people.

The major challenges and opportunities identified to manage Stemi in India according to Dr. Alexander  is the  structure of India’s healthcare system, which is advanced at one end in the urban India and basic at the other end in the rural areas with poor infrastructure to manage  medical emergencies calling the need for greater investment in acute reperfusion therapy. The  gap has been most apparent for pre hospital emergency medical systems (EMS), which until recently were almost non-existent. There is also  inadequate public and private health insurance programmes placing  Stemi patients and their families at great personal financial risk from treatments, contributing to the under utilization of evidence-based therapies, he said.

 Indian healthcare needs to adopt a  better acute reperfusion therapy to manage Stemi in India. Approval of two generic drugs - tenecteplase and reteplased by the Drug Controller General of India is a major step towards developing viable Stemi care in the country. The  second-generation drugs for fibrinolytic therapy improve reperfusion rates and outcomes in Stemi patients. New data on adjunctive therapy with clopidogrel may also expand the benefits of fibrinolytic therapy. An  improved understanding of the role of PCI approach, which is a  combination of immediate pharmacological reperfusion with invasive cardiac procedures, suggests controlling  high-risk patients. Availability of newer generation and less expensive generic Indian stents will significantly expand PCI to broader populations, he said.