Consensus statement: improvement in care and outcomes for patients with ST‐elevation myocardial infarction with timely reperfusion therapy: a pharmaco-invasive approach
DOI:
https://doi.org/10.18203/2349-3933.ijam20205052Keywords:
Acute coronary syndrome, Pharmaco-invasive therapy, ST-elevation myocardial infarction, Cardiac rehabilitationAbstract
The prevalence of cardiovascular diseases continues to increase in India, with a rapid epidemiological transition. Timely management of ST-elevation myocardial infarction (STEMI)is the key to decrease mortality and morbidity rates. In India, patients most often do not receive optimal therapy owing to a number of factors such as socio-economic constraints, lack of knowledge, geographical restrictions etc, leading to suboptimal outcomes. The timely delivery of optimal reperfusion strategy for STEMI patients is immensely challenging for physicians, due to several reasons. Primary percutaneous coronary Intervention (PCI) is still a global gold standard for the treatment of STEMI. Delayed case presentation is a significant challenge, especially in Indian tier towns/cities, because of prolonged transportation time or traffic delays with regards to reaching a PCI facility. Keeping in mind the accessibility to PCI facility because of geographical locations as well as affordability concerns especially in smaller Indian towns, pharmaco-invasive approach is almost as effective and a practical approach for reduction of morbidity and mortality rates. Timely establishment of reperfusion therapy is critical for improving myocardial salvage in patients with STEMI. There is an urgent need for developing strategies for efficient STEMI management, such as timely delivery of reperfusion therapy; reinforcement of health system and professionals, implementation of guideline-based interventions, streamlined insurance policy and greater emphasis on patient awareness for detection of symptoms. In addition to the timely reperfusion therapy and other standard care drugs, statins and potassium channel activators have demonstrated clinically significant improvements in the outcome of STEMI management.
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References
Prabhakaran D, Jeemon P, Roy A. Cardiovascular Diseases in India: Current epidemiology and future directions. Circulation. 2016;133(16):1605-20.
Annangi S, Singh T, Maskey A, Gaurav K. Intrathoracic extension of pancreatic pseudo cyst: a rare cause of hemoptysis. Chest. 2019;156(4):A886.
Singh A, Grossman SA. Coronary Syndrome, Acute. Stat Pearls. 2017.
Hwang C, Levis JT. ECG diagnosis: ST-elevation myocardial infarction. Perm J. 2014;18(2):e133.
Alex AG, Lahiri A, Devika. Observational study comparing pharmacoinvasive strategy with primary percutaneous coronary intervention in patients presenting with ST elevation myocardial infarction to a tertiary care centre in India. J Postgrad Med. 2018;64(2):80-5.
Ibanez B, James S, Agewall S. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2017;39(2):119-77.
Wald DS, Morris JK, Wald NJ. Randomized trial of preventive angioplasty in myocardial infarction. N Engl J Med. 2013;369:1115-23.
Bueno H, Betriu A, Heras M, Alonso JJ, Cequier A, García EJ, et al. Primary angioplasty vs. fibrinolysis in very old patients with acute myocardial infarction: TRIANA (TRatamiento del InfartoAgudo de miocardioeNAncianos) randomized trial and pooled analysis with previous studies. Eur Heart J. 2010;32(1):51-60
Gershlick AH, Khan JN, Kelly DJ, Greenwood JP, Sasikaran T, Curzen N, et al. Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and multivessel disease: the CvLPRIT trial. J Am Coll Cardiol. 2015;65(10):963-72.
Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2018.
Mohanan PP, Mathew R, Harikrishnan S, Krishnan MN, Zachariah G, Joseph J, et al. Presentation, management, and outcomes of 25 748 acute coronary syndrome admissions in Kerala, India: results from the Kerala ACS Registry. Eur Heart J. 2013;34(2):121-9.
Xavier D, Pais P, Devereaux PJ, Xie C, Prabhakaran D, Reddy KS, et al. Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data. Lancet. 2008;371(9622):1435-42.
El Guindy AM. STREAM and FAST-MI - Pharmacoinvasive therapy: A continued role for fibrinolysis in the primary PCI era. Glob Cardiol Sci Pract. 2014;2014(2):56-60.
Armstrong PW, Gershlick AH, Goldstein P. Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction. N Engl J Med. 2013;368(15):1379-87.
Danchin N, Puymirat E, Steg PG. Five-year survival in patients with ST-segment-elevation myocardial infarction according to modalities of reperfusion therapy: the French Registry on Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction (FAST-MI) 2005 Cohort. Circulation. 2014;129(16):1629-36.
Cahill TJ, Kharbanda RK. Heart failure after myocardial infarction in the era of primary percutaneous coronary intervention: Mechanisms, incidence and identification of patients at risk. World J Cardiol. 2017;9(5):407-15.
Meadows ES, Bae JP, Zagar A. Rehospitalization following percutaneous coronary intervention for commercially insured patients with acute coronary syndrome: a retrospective analysis. Brit Med Cent Res Notes. 2012;5:342.
Testa L, Van Gaal WJ, Biondi Zoccai GG, Agostoni P, Latini RA, Bedogni F, et al. Myocardial infarction after percutaneous coronary intervention: a meta-analysis of troponin elevation applying the new universal definition. Int J Medic. 2009;102(6):369-78.
Swieczkowski D, Mogielnicki M, Cwalina N, Zuk G, Pisowodzka I, Ciecwierz D, et al. Medication adherence in patients after percutaneous coronary intervention due to acute myocardial infarction: From research to clinical implications. Cardiol J. 2016;23(5):483-90.
Sharma V. Pharmaco-invasive strategy: An attractive alternative for management of ST-elevation myocardial infarction when timely primary percutaneous coronary intervention is not feasible. J Postgrad Med 2018;64:73-4
Alexander T, Juvale NJ, Dasbiswas A, Kubba S, Singh RK, Raja V. Pharmaco-invasive Therapy with Fibrinolytic Agents: A Potent Lifesaving Reperfusion Strategy in STEMI Patients in Metro/Tier-I Cities in India. J Assoc Physic Ind. 2018;66:76.
Vos GJ, Bennaghmouch N, Qaderdan K, Ten Berg JM. Management of the patient with an acute coronary syndrome using oral anticoagulation. Netherlands Hea J. 2015;23(9):407-14.
Mishra S, Ramakrishnan S, Babu AS. Management algorithms for acute ST elevation myocardial infarction in less industrialized world. Ind Heart J. 2017;69)1):S98-103.
Chopra HK. Challenges of STEMI care in India and the real world. Ind Heart J. 2015;67(1):15-7.
Tarkin JM, Kaski JC. Nicorandil and Long-acting Nitrates: Vasodilator Therapies for the Management of Chronic Stable Angina Pectoris. Eur Cardiol. 2018;13(1):23-8.
Wander GS, Chhabra ST. Critical analysis of various drugs used for thrombolytic therapy in acute myocardial infarction. Medic Update. 2013;23:109-16.
Adivitiya, Khasa YP. The evolution of recombinant thrombolytics: Current status and future directions. Bioengineered. 2017;8(4):331-58.
Dalal JJ, Alexander T, Banerjee PS, Dayasagar V, Iyengar SS, Kerkar PG, et al. 2013 consensus statement for early reperfusion and pharmaco-invasive approach in patients presenting with chest pain diagnosed as STEMI (ST elevation myocardial infarction) in an Indian setting. J Assoc Physic Ind 2014;62:473.
Shah K, Apsangikar P, Allu J. Clinical retrospective and prospective evaluation of efficacy and safety of reteplase in STEMI patients. Ind Med Gaz. 2012;146:479-87.
Ye Z, Su Q, Li L. The clinical effect of nicorandil on perioperative myocardial protection in patients undergoing elective PCI: A Systematic Review and Meta-Analysis. Sci Rep. 2017;7:45117.
Qi Q, Niu J, Chen T, Yin H, Wang T, Jiang Z. Intracoronary Nicorandil and the Prevention of the No-Reflow Phenomenon During Primary Percutaneous Coronary Intervention in Patients with Acute ST-Segment Elevation Myocardial Infarction. Med Sci Monit. 2018;24:2767-76.
Pang Z, Zhao W, Yao Z. Cardioprotective Effects of Nicorandil on Coronary Heart Disease Patients Undergoing Elective Percutaneous Coronary Intervention. Med Sci Monit. 2017;23:2924-30.
Feng C, Liu Y, Wang L, Niu D, Han B. Effects of early intracoronary administration of nicorandil during percutaneous coronary intervention in patients with acute myocardial infarction. Hea Lung Circul. 2019;28(6):858-65.
Feng C, Han B, Liu Y, Wang L, Niu D, Lou M, et al. Effect of nicorandil administration on myocardial microcirculation during primary percutaneous coronary intervention in patients with acute myocardial infarction. Adva Intervent Cardiol. 2018;14(1):26.
Sakata Y, Nakatani D, Shimizu M. Oral treatment with nicorandil at discharge is associated with reduced mortality after acute myocardial infarction. J Cardiol. 2012;59(1):14-21.
Yu SH, Li L, Zhang S. Clinical effect of intravenous thrombolysis combined with nicorandil therapy in patients with acute ST-segment elevation myocardial infarction. Tropic J Pharmaceut Res. 2016;15(6):1335-9.
Ostadal P. Statins as first-line therapy for acute coronary syndrome? Exp Clin Cardiol. 2012;17(4):227-36.
Khurana S, Gupta S, Bhalla H. Comparison of anti-inflammatory effect of atorvastatin with rosuvastatin in patients of acute coronary syndrome. J Pharmacol Pharmacotherapeut. 2015;6(3):130.
Wander GS, Hukkeri MY, Yalagudri S. Rosuvastatin: Role in Secondary Prevention of Cardiovascular. J Assoc Physic Ind. 2018;66:65-9.
Ko YG, Won H, Shin DH. Efficacy of early intensive rosuvastatin therapy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (ROSEMARY study). Am J Cardiol. 2014;114(1):29-35.
Jiménez-Navarro MF, Lopez-Jimenez F, Pérez-Belmonte LM, et al. Benefits of cardiac rehabilitation on cardiovascular outcomes in patients with diabetes mellitus after percutaneous coronary intervention. J Am Heart Assoc. 2017;6(10):e006404.
Kunjan K, Thakur JS, Vijayvergiya R. Effectiveness of cardiac rehabilitation in patients with myocardial infarction and percutaneous coronary intervention at a tertiary care hospital: A pilot intervention study. Int J Non-Commun Dis. 2018;3:104-10.
Turk-Adawi K, Sarrafzadegan N, Grace SL. Global availability of cardiac rehabilitation. Nat Rev Cardiol. 2014;11(10):586-96.
Grace SL, Turk-Adawi KI, Contractor A. Cardiac rehabilitation delivery model for low-resource settings. Heart. 2016;102(18):1449-55.
de MeloGhisi GL, Contractor A, Abhyankar M. Cardiac rehabilitation knowledge, awareness, and practice among cardiologists in India. Indi Hea J. 2018;70(5):753-5.
Beatty AL, Bradley SM, Maynard C. Referral to cardiac rehabilitation after percutaneous coronary intervention, coronary artery bypass surgery, and valve surgery: data from the clinical outcomes assessment program. Circulation. 2017;10(6):e003364.
