Resource and Infrastructure-Appropriate Management of ST-Segment Elevation Myocardial Infarction in Low- and Middle-Income Countries
Circulation, vol. 141, pp. 2004–2025
Abstract
The 143 low- and middle-income countries (LMICs) of the world constitute 80% of the world's population or roughly 5.86 billion people with much variation in geography, culture, literacy, financial resources, access to health care, insurance penetration, and healthcare regulation. Unfortunately, their burden of cardiovascular disease in general and acute ST-segment-elevation myocardial infarction (STEMI) in particular is increasing at an unprecedented rate. Compounding the problem, outcomes remain suboptimal because of a lack of awareness and a severe paucity of resources. Guideline-based treatment has dramatically improved the outcomes of STEMI in high-income countries. However, no such focused recommendations exist for LMICs, and the unique challenges in LMICs make directly implementing Western guidelines unfeasible. Thus, structured solutions tailored to their individual, local needs, and resources are a vital need. With this in mind, a multicountry collaboration of investigators interested in LMIC STEMI care have tried to create a consensus document that extracts transferable elements from Western guidelines and couples them with local realities gathered from expert experience. It outlines general operating principles for LMICs focused best practices and is intended to create the broad outlines of implementable, resource-appropriate paradigms for management of STEMI in LMICs. Although this document is focused primarily on governments and organizations involved with improvement in STEMI care in LMICs, it also provides some specific targeted information for the frontline clinicians to allow standardized care pathways and improved outcomes.
Authors 40
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University of Minnesota · Minneapolis VA Medical Center
Affiliation as printed
Division of Cardiology, University of Minnesota/VA Medical Center, Minneapolis (Y.C.)
Y. Chandrashekhar Y. Chandrashekhar, MD, Division of Cardiology (IIIC), Minneapolis VA Medical Center, 1 Veterans Dr., Minneapolis, MN 55417
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Kovai Medical Center and Hospital
Affiliation as printed
Division of Cardiology, Kovai Medical Center and Hospital, Coimbatore, India (T.A.)
Thomas Alexander Division of Cardiology, Kovai Medical Center and Hospital, Coimbatore, India (T.A.)
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Affiliation as printed
Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India (A.M.)
Ajit Mullasari Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India (A.M.)
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The University of Texas Southwestern Medical Center
Affiliation as printed
Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.J.K.)
Dharam J. Kumbhani Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.J.K.)
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American University of Beirut Medical Center · American University of Beirut
Affiliation as printed
Division of Cardiology, American University of Beirut Medical Center, Lebanon (S.A.)
Samir Alam Division of Cardiology, American University of Beirut Medical Center, Lebanon (S.A.)
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Instituto Nacional de Cardiología · Universidad Nacional Autónoma de México
Affiliation as printed
Nuclear Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Universidad Nacional Autonoma de Mexico, Mexico City (E.A.)
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Affiliation as printed
Building Healthy Cities, John Snow India Pvt Ltd, New Delhi (D.B.)
Damodar Bachani Building Healthy Cities, John Snow India Pvt Ltd, New Delhi (D.B.)
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Affiliation as printed
Netcare Unitas Hospital, City of Tshwane Metropolitan Municipality, Gauteng, South Africa (J.C.W.B.)
Jacobus Cornelius Wilhelmus Badenhorst Netcare Unitas Hospital, City of Tshwane Metropolitan Municipality, Gauteng, South Africa (J.C.W.B.)
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The Ohio State University Wexner Medical Center · The Ohio State University
Affiliation as printed
Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (R. Baliga)
Ragavendra Baliga Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (R. Baliga)
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Leiden University Medical Center
Affiliation as printed
Division of Cardiology, Leiden University Medical Center, The Netherlands (J.J.B.)
Jeroen J. Bax Division of Cardiology, Leiden University Medical Center, The Netherlands (J.J.B.)
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Brigham and Women's Hospital · Harvard University
Affiliation as printed
Division of Cardiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (D.L.B.)
Deepak L. Bhatt Division of Cardiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.)
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Affiliation as printed
Department of Cardiology and Cardiac Surgery, Azienda Ospedaliera Universitaria, Salerno, Italy (E.B.)
Eduardo Bossone Department of Cardiology and Cardiac Surgery, Azienda Ospedaliera Universitaria, Salerno, Italy (E.B.)
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Affiliation as printed
Triangulo Heart Institute, Uberlândia, Minas Gerais, Brazil (R. Botelho)
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Affiliation as printed
Department of Cardiology, Apollo Gleneagles Hospital, Kolkata, India (R.N.C.)
Rabindra Nath Chakraborthy Department of Cardiology, Apollo Gleneagles Hospital, Kolkata, India (R.N.C.)
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Affiliation as printed
Heart and Vascular Institute for Lee Health, Fort Myers, FL (R.A.C.)
Richard A. Chazal Heart and Vascular Institute for Lee Health, Fort Myers, FL (R.A.C.)
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Indian Council of Medical Research
Affiliation as printed
Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India (R.S.D., M.S.)
Rupinder Singh Dhaliwal Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India (R.S.D., M.S.)
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Hospital Fatuma Bourguiba Monastir
Affiliation as printed
Department of Cardiology, Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.)
Habib Gamra Department of Cardiology, Fattouma Bourguiba University Hospital, Monastir, Tunisia (H.G.)
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Sree Chitra Thirunal Institute for Medical Sciences and Technology
Affiliation as printed
Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India (S.P.H.)
Sivadasan Pillai Harikrishnan Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India (S.P.H.)
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Aga Khan University Hospital Nairobi · Aga Khan University Nairobi
Affiliation as printed
Division of Cardiology, Aga Khan University Medical College, Nairobi, Kenya (M.J., H.A.O.)
Mohamed Jeilan Division of Cardiology, Aga Khan University Medical College, Nairobi, Kenya (M.J., H.A.O.)
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Affiliation as printed
Division of Cardiology, St. Dominic’s Hospital, East London, South Africa (D.I.K.)
David Ian Kettles Division of Cardiology, St. Dominic's Hospital, East London, South Africa (D.I.K.)
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Affiliation as printed
Lumen Global Foundation, Miami, FL (S.M.)
Sameer Mehta Lumen Global Foundation, Miami, FL (S.M.)
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Affiliation as printed
Department of Cardiology, Westfort Hi-Tech Hospital, Thrissur, Kerala, India (P.P.M.)
Padhinhare P. Mohanan Department of Cardiology, Westfort Hi-Tech Hospital, Thrissur, Kerala, India (P.P.M.)
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Affiliation as printed
Department of Cardiology, St.-Marien-Hospital, Mülheim an der Ruhr, Germany (C.K.N.)
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All India Institute of Medical Sciences
Affiliation as printed
Department of Cardiology, All India Institute of Medical Sciences, New Delhi (N.N., A.R.)
Nitish Naik Department of Cardiology, All India Institute of Medical Sciences, New Delhi (N.N., A.R.)
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University of Cape Town · Groote Schuur Hospital
Affiliation as printed
Division of Cardiology, Groote Schuur Hospital, University of Cape Town, South Africa (M.N.)
Mpiko Ntsekhe Division of Cardiology, Groote Schuur Hospital, University of Cape Town, South Africa (M.N.)
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Aga Khan University Hospital Nairobi · Aga Khan University Nairobi
Affiliation as printed
Division of Cardiology, Aga Khan University Medical College, Nairobi, Kenya (M.J., H.A.O.)
Harun Argwings Otieno Division of Cardiology, Aga Khan University Medical College, Nairobi, Kenya (M.J., H.A.O.)
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St.John's Medical College Hospital
Affiliation as printed
Division of Clinical Trials, St. John’s Research Institute, St. John’s Medical College, Bangaluru, India (P.P.)
Prem Pais Division of Clinical Trials, St. John's Research Institute, St. John's Medical College, Bangaluru, India (P.P.)
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Affiliation as printed
Universidad de Buenos Aires, Argentina (D.J.P.)
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Public Health Foundation of India
Affiliation as printed
Centre for Chronic Disease Control, Public Health Foundation of India, New Delhi (D.P.)
Dorairaj Prabhakaran Centre for Chronic Disease Control, Public Health Foundation of India, New Delhi (D.P.)
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Public Health Foundation of India
Affiliation as printed
Public Health Foundation of India, New Delhi (K.S.R.)
K. Srinath Reddy Public Health Foundation of India, New Delhi (K.S.R.)
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Adan Hospital · Ministry of Health
Affiliation as printed
Ministry of Health of the State of Kuwait, Adan Hospital, Kuwait City (M.R.)
Mustafa Redha Ministry of Health of the State of Kuwait, Adan Hospital, Kuwait City (M.R.)
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All India Institute of Medical Sciences
Affiliation as printed
Department of Cardiology, All India Institute of Medical Sciences, New Delhi (N.N., A.R.)
Ambuj Roy Department of Cardiology, All India Institute of Medical Sciences, New Delhi (N.N., A.R.)
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Indian Council of Medical Research
Affiliation as printed
Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India (R.S.D., M.S.)
Meenakshi Sharma Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India (R.S.D., M.S.)
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Affiliation as printed
Virginia Heart, Inova Alexandria Hospital, Alexandria (R.S.)
Robert Shor Virginia Heart, Inova Alexandria Hospital, Alexandria (R.S.)
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Affiliation as printed
Division of Cardiology, Wilgers Hospital, Pretoria, South Africa (F.A.S.)
Frederik Adriaan Snyders Division of Cardiology, Wilgers Hospital, Pretoria, South Africa (F.A.S.)
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National Heart Centre Singapore
Affiliation as printed
Department of Cardiology, National Heart Centre, Singapore (J.W.C.T.)
Jack Weii Chieh Tan Department of Cardiology, National Heart Centre, Singapore (J.W.C.T.)
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Affiliation as printed
Centra Stroobants Heart Center, Lynchburg General Hospital, VA (C.M.V.)
C. Michael Valentine Centra Stroobants Heart Center, Lynchburg General Hospital, VA (C.M.V.)
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Affiliation as printed
Sanger Heart and Vascular Institute, Charlotte, NC (B.H.W.)
B. Hadley Wilson Sanger Heart and Vascular Institute, Charlotte, NC (B.H.W.)
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Population Health Research Institute · McMaster University
Affiliation as printed
Population Health Research Institute, McMaster University School of Medicine, Hamilton, ON, Canada (S.Y.)
Salim Yusuf Population Health Research Institute, McMaster University School of Medicine, Hamilton, ON, Canada (S.Y.)
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Icahn School of Medicine at Mount Sinai
Affiliation as printed
Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York (J.N.)
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