Reperfusion therapy for ST elevation myocardial infarction in low- to middle-income countries: a clinical consensus statement of the Association for Acute CardioVascular Care (ACVC), the European Association of Percutaneous Cardiovascular Interventio

Suboptimal care for ST-elevation myocardial infarction (STEMI) in low- and middle-income countries is a significant problem. Registries from Latin America, Africa, and Asia show that <65% of patients receive reperfusion therapy, and widespread treatment delays and a lack of access to optimal therapies lead to preventable deaths and complications. While current guidelines provide a blueprint for care, their implementation in low-resource settings requires specific guidance that considers geographical, logistical, and economic realities. This clinical consensus offers a new framework for developing STEMI care systems in these countries. We propose a flexible, three-model pathway, based on the initiatives such as STEMI India and Stent - Save a Life. The models include a fibrinolysis model, a pharmaco-invasive strategy model, and a primary percutaneous coronary intervention (PCI) model. This approach emphasizes adaptability, allowing local STEMI systems to be tailored to specific circumstances. The framework also addresses specific, common challenges, such as delayed access to primary PCI, reperfusion in patients with cardiogenic shock and expected delayed PCI, fibrinolysis in patients with a high risk of bleeding, and the absence of fibrin-specific fibrinolytics, catheterization labs, or reperfusion therapies at all. The consensus also highlights the importance of continuous improvement, patient education, and adopting secondary prevention strategies. Ultimately, this framework is designed to help healthcare providers and leaders in developing countries improve their regional STEMI care systems.

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Publication Details

Journal
European Heart Journal Acute Cardiovascular Care
Published
2025-09-03
DOI
https://doi.org/10.1093/ehjacc/zuaf114
Primary Topic
Acute Myocardial Infarction Research
Type
article
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article

Reperfusion therapy for ST elevation myocardial infarction in low- to middle-income countries: a clinical consensus statement of the Association for Acute CardioVascular Care (ACVC), the European Association of Percutaneous Cardiovascular Interventio

Hélder Pereira, Amina Rakisheva, Alfonsina Candiello, Jan J. Piek et al.
European Heart Journal Acute Cardiovascular Care
Acute Myocardial Infarction Research
article

Reperfusion therapy for ST elevation myocardial infarction in low- to middle-income countries: a clinical consensus statement of the Association for Acute CardioVascular Care (ACVC), the European Association of Percutaneous Cardiovascular Interventio

Hélder Pereira, Amina Rakisheva, Alfonsina Candiello, Jan J. Piek, Najat Mouine, Ingo Ahrens, Diana A. Gorog, Sigrun Halvorsen, Mohamed Sobhy, Emanuele Barbato, Diego Araiza‐Garaygordobil, A P Dippenaar, Gianluca Calogero Campo, Dejan Orlić, Carlos L. Alviar, Alexandra Arias‐Mendoza, Rahima Gabulova, Kurt Huber
article en

Abstract

Suboptimal care for ST-elevation myocardial infarction (STEMI) in low- and middle-income countries is a significant problem. Registries from Latin America, Africa, and Asia show that <65% of patients receive reperfusion therapy, and widespread treatment delays and a lack of access to optimal therapies lead to preventable deaths and complications. While current guidelines provide a blueprint for care, their implementation in low-resource settings requires specific guidance that considers geographical, logistical, and economic realities. This clinical consensus offers a new framework for developing STEMI care systems in these countries. We propose a flexible, three-model pathway, based on the initiatives such as STEMI India and Stent - Save a Life. The models include a fibrinolysis model, a pharmaco-invasive strategy model, and a primary percutaneous coronary intervention (PCI) model. This approach emphasizes adaptability, allowing local STEMI systems to be tailored to specific circumstances. The framework also addresses specific, common challenges, such as delayed access to primary PCI, reperfusion in patients with cardiogenic shock and expected delayed PCI, fibrinolysis in patients with a high risk of bleeding, and the absence of fibrin-specific fibrinolytics, catheterization labs, or reperfusion therapies at all. The consensus also highlights the importance of continuous improvement, patient education, and adopting secondary prevention strategies. Ultimately, this framework is designed to help healthcare providers and leaders in developing countries improve their regional STEMI care systems.

European Heart Journal Acute Cardiovascular CareVol. 14(11)
Almaty Management University (KZ), Sigmund Freud Privatuniversität Wien (AT), Mohammed V University (MA), Oslo University Hospital (NO), University of Hertfordshire (GB), University of Freiburg (DE), King's College London (GB), University of Oslo (NO), Azerbaijan Medical University (AZ), University Medical Center Freiburg (DE), Military Hospital (PK), Edinburgh Royal Infirmary (GB), University of Belgrade (RS), Azienda Unità Sanitaria Locale di Ferrara (IT), Lung Institute (US), Amsterdam Neuroscience (NL), Bellevue Hospital Center (US), Krankenhaus der Augustinerinnen (DE), Kovai Medical Center and Hospital (IN), CTO Andrea Alesini (IT), South African Heart Association (ZA), Azienda Ospedaliera Sant'Andrea (IT), Arcispedale Sant'Anna (IT), Hospital Garcia de Orta (PT), Instituto Nacional de Cardiología (MX), Instituto Cardiovascular de Buenos Aires (AR), Imperial College London (GB), Alexandria University (EG), Sapienza University of Rome (IT), University of Amsterdam (NL)
Openalex Percentile: Top 63%
Acute Myocardial Infarction Research
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