Why the study?
In India, logistical and socioeconomic challenges often make primary PCI impractical for STEMI, creating a need to optimize treatment approaches using a pharmaco-invasive strategy alongside secondary prevention and cardiac rehabilitation.
In Indian settings where timely primary PCI is often unavailable, a pharmaco-invasive strategy is a practical and effective alternative for STEMI management.
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Endorses pharmaco-invasive therapy for STEMI in India when primary PCI is delayed; extends guidelines to resource-limited settings.
In India, patients with acute coronary syndrome (ACS) tend to present with higher percentage of ST-elevation myocardial infarction (STEMI). Numerous existing challenges like patient unawareness, lack of structured STEMI care systems, inadequacy of promptly available facilities and unequipped ambulances for patient transport make it difficult to achieve optimal STEMI treatment. Also, due to socio-economic diversities prevailing in India, a large proportion of the entire population has access to only basic primary healthcare and are unable to afford proper medical facilities. Judicious and timely reperfusion strategy has been the mainstay of STEMI management. Even though, percutaneous coronary intervention (PCI) continues to be the gold standard for treating STEMI worldwide, it is not the ideal strategy in many Indian settings, especially in villages and smaller towns/cities. In such scenarios, pharmaco-invasive approach has proved to be a better reperfusion therapeutic strategy for improving treatment outcomes and subsequently reducing morbidity and mortality. The purpose of this consensus article is to highlight the clinical perspectives of Indian cardiologists at identifying and addressing the need gaps currently existing in India for optimization of STEMI treatment approaches. The experts shared their views on the rationale of pharmaco-invasive approach and highlighted the significance of commonly used thrombolytic agents, STEMI treatment protocols, secondary prevention and cardiac rehabilitation.
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Dasbiswas et al. (2021) conducted a review in ST-elevation myocardial infarction (STEMI). Pharmaco-invasive therapy vs. Primary percutaneous coronary intervention (PPCI) was evaluated. Pharmaco-invasive therapy is recommended as an effective and practical reperfusion strategy for STEMI management in Indian settings where timely primary PCI is not feasible.
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