Cardiological Society of India: Position statement for the management of ST elevation myocardial infarction in India

Guha, Santanu; Sethi, Rishi; Ray, Saumitra; Bahl, Vinay K.; Shanmugasundaram, Saseendar; Kerkar, P. G.; Ramakrishnan, Sivasubramanian; Yadav, Rakesh Kumar; Chaudhary, Gaurav; Kapoor, Aditya; Mahajan, Ajay; Sinha, Ajay; Mullasari, Ajit S.; Pradhan, Akshyaya; Banerjee, Amal; Singh, B. P.; Balachander, Jayaraman; Pinto, Brian; Manjunath, C.N.; Makhale, C.N.; Roy, Debabrata; Kahali, Dhiman; Zachariah, George; Wander, Gurpreet Singh; Kalita, H.C.; Chopra, HK; Abdullakutty, Jabir; Tharakan, Jaganmohan A.; Gnanaraj, Justin Paul; Venogopal, K.; Baksi, Krishna; Ganguly, Kajal; Goswami, Kewal C.; Somasundaram, Meyappan; Chhetri, M K; Hiremath, M.S.; Ravi, M.S.; Das, Mrinal Kanti; Khanna, Narendra N.; Jayagopal, P.B.; Asokan, PK; Deb, Pradip Kumar; Mohanan, P.P.; Chandra, Praveen; Girish, R.; Nath, Onkar; Gupta, Rakesh; Raghu, Cherukupalli; Dani, Sameer; Bansal, Sandeep; Tyagi, Sanjay; Routray, Satyanarayan; Tewari, Satyendra; Chandra, Sarat P; Mishra, Shishu; Datta, Sibananda; Chaterjee, S.S.; Kumar, Soumitra; Mookerjee, Soura; Victor, Suma M.; Mishra, Sundeep; Alexander, Thomas; Samal, Umesh Chandra; Trehan, Vijay

doi:10.1016/j.ihj.2017.03.006

Cited by 57 publications

(47 citation statements)

References 193 publications

(273 reference statements)

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“…ST‐segment elevation myocardial infarction (STEMI) is a life‐threatening manifestation of coronary artery disease (CAD) requiring prompt recognition and emergent reperfusion. The proportion of patients with acute coronary syndromes (ACS) presenting with STEMI are also higher in India . Although there are concerns about increasing incidence of MI in young worldwide, the mean age of presentation with ACS in India is ~55 years, approximately 10 years younger than reports from high‐income countries .…”

Section: Introductionmentioning

confidence: 99%

“…Although there are concerns about increasing incidence of MI in young worldwide, the mean age of presentation with ACS in India is ~55 years, approximately 10 years younger than reports from high‐income countries . More than 50% of patients with STEMI in India are of lower socioeconomic status and are unable to afford basic healthcare, let alone out‐of‐pocket costs for primary percutaneous coronary intervention (PCI) and associated medical therapies . Furthermore, the practice patterns for management of STEMI in India suffer from significant limitations including delays and underutilization of reperfusion therapy and lower rates of adherence to evidence‐based medical therapy .…”

Section: Introductionmentioning

confidence: 99%

“…The proportion of patients with acute coronary syndromes (ACS) presenting with STEMI are also higher in India. 5 Although there are concerns about increasing incidence of MI in young worldwide, [6][7][8][9][10][11][12] the mean age of presentation with ACS in India is~55 years, approximately 10 years younger than reports from high-income countries. 13 More than 50% of patients with STEMI in India are of lower socioeconomic status and are unable to afford basic healthcare, let alone out-of-pocket costs for primary percutaneous coronary intervention (PCI) and associated medical therapies.…”

mentioning

confidence: 99%

“…13 More than 50% of patients with STEMI in India are of lower socioeconomic status and are unable to afford basic healthcare, let alone out-of-pocket costs for primary percutaneous coronary intervention (PCI) and associated medical therapies. 5,14 Furthermore, the practice patterns for management of STEMI in India suffer from significant limitations including delays and underutilization of reperfusion therapy and lower rates of adherence to evidence-based medical therapy. 13 Compounding these factors are the significant inter-regional disparities in socioeconomic status across India.…”

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confidence: 99%

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Design and rationale of the North Indian ST‐Segment Elevation Myocardial Infarction Registry: A prospective cohort study

Arora

Qamar

Gupta

et al. 2019

Clinical Cardiology

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ST‐segment elevation myocardial infarction (STEMI) is associated with increased mortality and morbidity. Although remarkable progress has been made in the management of STEMI in high‐income countries, contemporary data to evaluate processes and outcomes of STEMI care in India is limited. The North Indian ST‐segment elevation myocardial infarction (NORIN STEMI) registry is a prospective cohort study based at government funded and largely free of cost tertiary medical centers in New Delhi, India. These hospitals serve a large proportion of the patients with lower socioeconomic status presenting from multiple states in India, as many centers in these states lack adequate specialized cardiovascular care. The study has been approved by the Institutional Review Boards of each institution and informed consent has been obtained from study participants. The NORIN STEMI registry aims to provide important insights regarding contemporary risk factors profiles, practice patterns, and prognosis in patients with STEMI in an underserved population in North India. These findings may identify opportunities to improve the outcomes of patients with STEMI in India.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Design and rationale of the North Indian ST‐Segment Elevation Myocardial Infarction Registry: A prospective cohort study

Arora

Qamar

Gupta

et al. 2019

Clinical Cardiology

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“…Given the wide disparity of available resources to treat AMI in developing countries, major efforts are needed to strengthen primary prevention programmes at community level. 1,2 Management of acute MI is fairly standardized now. Thrombolytic therapy in the golden (0-3hrs) hours is still a gold standard treatment for acute myocardial infarction (AMI) when instituted at the earliest reducing mortality and morbidity.…”

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ST elevated myocardial infarction: clinical manifestation and outcomes of thrombolysis in a tertiary care hospital

Ravishankar

Kumar

2018

Int J Adv Med

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Background: Acute myocardial infarction has reached enormous proportion in the developing countries and it is speculated that atherosclerotic heart disease will replace infectious disease as the leading cause of death in India. It has been shown that the thrombolytic therapy is underutilized. So, the study was taken to study the clinical manifestations and outcome of thrombolytic therapy in STEMI.Methods: The study was conducted for a period of 18 months in a tertiary care centre during which 100 cases of STEMI admitted to ICCU were included in the study, after fulfilling the inclusion criteria for thrombolysis, data related to clinical profile and outcome of thrombolysis was collected. SPSS 16 was used to analyse the data. Descriptive statistics like proportions mean and SD were computed.Results: Incidence of STEMI was high among subjects in the age group 51-60 years. Males were more affected (72%). Smoking, hypertension, hyperlipidemia and diabetes mellitus were the most common risk factors. Chest pain (92%) was the most common symptom. Majority (56%) were admitted within 6 hours of onset of symptoms. Anterior wall infarction was most common type of myocardial infarction. Majority (82%) were admitted in either Killips I/II class. Left Ventricular failure and Arrhythmias were most common complication. 64% patients had objective evidence in a form of ECG with ST-T resolution (>50%) between 1-6 hours, 18% between 6-24 hours and 18% patients had no significant resolution even after 24 hours. Echocardiography showed good left ventricle function (LVEF >45%) in 70% and 30% of the patients showed reduced ejection fraction (LVEF<45%). Mortality was seen in 8% of cases.Conclusions: Smoking, hyperlipidemia, diabetes mellitus and hypertension were most important risk factors for MI in the study. Coronary pain relief was most frequent and early marker of reperfusion. The ST segment elevation resolution has been widely accepted as most reliable objective criteria of coronary reperfusion. Hence ST segment resolution is regarded as a marker of salvaged myocardium by post-thrombolytic reperfusion. Early reperfusion of the ischaemic myocardial tissue with thrombolytic therapy decreases the morbidity and mortality.

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Frequency and nature of drug‐related problems in patients with acute coronary syndrome: role of the clinical pharmacist in coronary care practice

Gona

Shambu

Ramesh

2020

Pharmacy Practice and Res

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Background: Patients with acute coronary syndrome (ACS) often have associated problems either as a reason or as a corollary of the disease and drug-related problems (DRPs) are more likely to precipitate despite the presence of standard guidelines. This research is intended to evaluate the nature and extent of DRPs and examine their clinical significance in the presence of a clinical pharmacist. Methods: A clinical pharmacist-initiated cross-sectional study was carried out in the Department of Cardiology unit in a tertiary care teaching hospital for a year. The patient's medications were audited for DRPs using PCNE V 8.0.1 and drug-interactions by Micromedex. Descriptive and inferential statistics were applied whenever required by using SPSS v 25.0. Results: A total of 1120 patients screened, 432 patients were enrolled in the study by obtaining consent. The majority were in the age group 41-60 years of whom (294 (68.05 %)) were males. DRPs (367) were identified in (225 (52%)) patients of which (243 (66.13%) were due to problems in prescription, 27 (1.90%) treatment duration, followed by dispensing 43 (11.71%), drug use process 41 (11.17%) and patient-related 38 (10.35%)). The overall incidence of DRPs was 51.85%. Most risk factors were associated with DRPs (p < 0.0001). Conclusion: Drug-related problems are common in patients with acute coronary syndrome due to comorbidities and its related polypharmacy. Physician and clinical pharmacist collaboration can help in the early detection of DRPs, and alleviate the adversities emphasising optimal pharmacotherapeutic management.

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Cardiological Society of India: Position statement for the management of ST elevation myocardial infarction in India

Cited by 57 publications

References 193 publications

Design and rationale of the North Indian ST‐Segment Elevation Myocardial Infarction Registry: A prospective cohort study

Design and rationale of the North Indian ST‐Segment Elevation Myocardial Infarction Registry: A prospective cohort study

ST elevated myocardial infarction: clinical manifestation and outcomes of thrombolysis in a tertiary care hospital

Frequency and nature of drug‐related problems in patients with acute coronary syndrome: role of the clinical pharmacist in coronary care practice

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