Developing a STEMI System of Care for Low- and Middle-Income Countries: The STEMI-India Model

Abstract

Coronaryarterydisease(CAD)isamajorcontributortodeath and disability in India, and its overall prevalence hasrisen dramatically over the past 2 decades. Current datashowthat3%to4%ofIndiansinruralareasand8%to10%inurbanareashaveCAD[1].Furthermore,thepatientswithCAD in the Indian subcontinent appear to be at greater riskof acute presentations of CAD, present 5 years early withacute events, and demonstrate worse outcomes followingsuch events.Data about contemporary trends in ST-segment eleva-tion myocardial infarction (STEMI) patients come fromCREATE (Treatment and Outcomes of Acute CoronarySyndromes in India), a large clinical registry of acute coro-nary syndrome patients from 89 large hospitals in 10regions and cities across India [2]. Among the >20,000patients enrolled in CREATE, over 60% had STEMI, aproportion that is substantially higher than in NorthAmericanandEuropeanregistries[3,4].Thirty-fourpercentof the STEMI patients were 40 million people are pushed into massivedebts to access health care. The consequences of out-of-pocket payment for acute care can have a devastating ef-fect on poverty and rural indebtedness [5]. The scenario isprobablysimilarinmostlow-andmiddle-incomecountries(LMIC).Therefore,anySTEMIsystemofcaredevelopedforthese countries will have to be equitable and inclusive sothat this vulnerable population is not ignored.