India has the highest burden of Acute Coronary Syndrome (ACS) patients in the world. Patients who suffer from the ACS are younger (56.3 years) and have a higher proportion (more than 60.6 per cent) of ST-elevation myocardial infarction (STEMI) than patients in developed countries, according to a study by the Indian Heart Journal . STEMI is a type of heart attack that can be defined as a development of full thickness cardiac muscle damage resulting from an acute interruption of blood supply to a part of the heart and can be demonstrated by ECG (electrocardiography) change of ST-segment elevation.
However, coronary artery disease (CAD) is a major contributor of death and disability in India, and its overall prevalence has risen dramatically over the past two decades. Approximately 3 to 4 per cent of Indians in rural areas and 8 to 10 per cent in urban areas have CAD. Moreover, Indians are more likely to develop CAD at younger ages during an individual’s working years, and as a result, there is an extremely high loss of potentially productive years of life. Among working-age adults (35–64 years old), nearly 18 million productive years of life are expected to be lost due to CAD by 2030, a number more than nine times higher than expected in the U.S.
Recent studies suggest that poor patients with CAD appear to be at greater risk of acute presentations of CAD and have worse outcomes following such events. The most complete data about contemporary trends in STEMI patients come from CREATE, a large clinical registry of acute coronary syndrome patients from 89 large hospitals in 10 regions and cities across India.
Among the more than 20,000 patients that enrolled in CREATE, over 60 per cent had STEMI, a proportion that is substantially higher than in North American and European registries. STEMI patients also were younger and had a lower socioeconomic status when compared with non-STEMI patients. The average time from the onset of symptoms to hospital arrival was five hours in STEMI patients, again more than double the delay reported in developed countries. Finally, approximately 60 per cent received fibrinolytic therapy (injections) and only 8 per cent underwent percutaneous coronary intervention — PCI (referred to as angioplasty in lay terms), during their hospitalisation, suggesting substantial room for improvement in the use of acute reperfusion (restoration of blood supply) therapy.
Interventional Cardiologist and National Co-ordinator of Trans-catheter Cardiovasular Therapeutics (TCT) – India P Ramesh Babu says emergency angioplasty was the best mode of treatment of ASC. While 90 per cent of the acute heart attacks in the western world were being treated with emergency angioplasty, only 8 to 13 per cent of them were being treated with emergency angioplasty in urban India and only 2 per cent in rural India.
TCT-India launched a week-long programme to promote awareness on the life saving procedure of emergency angioplasty. This procedure not only saves lives but it also drastically reduces damage to the heart tissue enabling the patients to lead normal productive lives. As part of the programme, interventional cardiologists in all the 13 districts of Andhra Pradesh will record authentic data pertaining to accessibility, use and quality of health care available to ASC patients, improving the awareness of lay public and also the first contact physicians by educating them about emergency care and acute case management for those victims of first event who survive long enough to receive intervention. The week-long programme began on July 25.
