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Justin Paul,
M.B.,B.S., M.D., D.N.B., D.M.,

Professor of Cardiology
Madras Medical College
Back ground of the plan
Treatment for STEMI

Fibrinolysis Primary Angioplasty

Only 6-10% of STEMI patients get Primary Angioplasty in India
Availability of Cardiac Cath lab
Availability of Cardiologist
Distance and Transport reasons
Financial reasons
Logistic reasons
Pharmaco Invasive Therapy
Thrombolysis within 30 min of FMC

PCI within 3-24 hours of lysis

Widens the time window

Logistically easier to accomplish especially during off hours
Ideal strategy in rural India since
Transportation times can be long
Cath labs located in metros
The feasibility of this therapy in Tamil Nadu setting in a public-private partnership mode was tested in TN
STEMI pilot study
Medical College Hospitals with Cardiology Department, Faculty, no Cath lab -7

Phase 2

Medical Colleges -7
With Cardiology
No Cath lab.
Kilpauk Medical College
is not shown in the map

Their feeding GH are also

Medical College Hospitals with no Cardiology Department, no Faculty, no Cath lab -8

Phase 3
Medical Colleges-8
No Cardiology department
No faculty
No Cath lab.
Their feeding GH are also
What is now necessary to enrich TN Govt STEMI Health care

8 Cath labs, 6 Cath labs,

8 + 16 Cardiologists 6 Cardiologists
Government Cathlab network in TN Private
v 125 Cathlabs

c 5 Cathlabs
9 Cathlabs
TN-STEMI- Milestones
Hub-spoke- Pilot study of Primary PCI vs Pharmaco-invasive
(GO (2D)5, Health and Family Welfare Department 07.02.2013)
RePAMI study
(GO (2D) No. 159 Health and Family Welfare Department dated 27.10.2016)
Establishment of Cathlabs- NHM ROP 16-17
TANII-upscaling Hub & Spoke
(GO-303, Health and Family Welfare Department dated 31.08.2017)
Strengthening of ICUs in Hub and Spoke- NHM ROP 17-18
Draft- Cardiac care policy
Pilot study- 1- Comparison of the Primary PCI and
Pharmaco-invasive Strategy
Primary PCI (Percutaneous coronary intervention) Pharmaco-invasive Strategy

All patients with S TE MI should As good as primary P CI

Widens the time window
have a door to balloon time of
Logistically easier to accomplish
less than 90 minutes.
especially during off hours
The Lab should function 24x7
Aim: Lysis within 30 min of first
medical contact followed by P CI
2420 patients with 4 hubs and 35 within 3-24 hours.
spoke hospitals benefited in the 18
months study. Ideal strategy in India since
Transportation times can be long and
Pilot study- 2 (Ongoing)
A prospective, observational, study of Pharmaco- invasive strategy
with Reteplase in Indian patients with STEMI- RePAMI.

HUB hospital: Kovai Medical Centre, HUB hospital: Government Mohan Kumara
Coimbatore Mangalam Medical College & Hospital, Salem

SPOKE hospital: SPOKE hospital:

Pollachi Cardiac Centre Government Head Quarters Hospital, Mettur

Dam, Salem

Christian Fellowship Hospital, Oddanchatram Government Head Quarters Hospital, Erode

Government Hospital, Tirupur Government Hospital, Omalur, Salem

Budget available for TN-STEMI
Source of Amount (in
S. No. Activity funding crores)

1 Establishment of Cathlab NHM 35.00

Establishment of STEMI
2 network TANII 9.25

3 Strengtheing of ICU NHM 6.75

Total 51.00
Kindly update the present ambulance
network with present picture

Network in
Tamil Nadu
TN STEMI- Plan for scaling up

108 Ambulance HUB hospital (Cath lab)

Fixing STEMI kits in 300 Establish Cathlab in 9 Medical HUB hospital (Cath lab)
College Hospitals
ambulances across alll Designate a STEMI
Stanley MCH
districts coordinator at each HUB
Kilpauk MCH
Establish a HUB at 108 call Chengalpet MCH Establish console room
centre to coordinate Vellore MCH with monitors to
STEMI cases Trichy MCH
coordinate STEMI cases
Provide linkage with HUB Tanjore MCH ICCU strengthening
and SPOKE hospitals Madurai MCH Provide HR as per
Improve the case load Tirunelveli MCH pattern
from 6% Coimbatore MCH
TN STEMI- Plan for scaling up

SPOKE hospitals Training

EMTs, Call centre Physicians of
Establish 30 Spoke 108
hospitals in district/ sub- Protocols
Spoke hospital STEMI
district MI protocol in Emergency coordinator, Physicians and Staff
Provide linkage with 108 Room nurses
and HUB hospital STEMI protocols HUB hospital STEMI
coordinator, Professor, Assistant
Designate a STEMI N-STEMI protocols professors, Staff nurses,
coordinator Technicians in Cardiac unit
Publishing of above
Provide STEMI kit Plan of action drawn to train the
protocols under TAEI above STEMI protocols in next 6
Strengthening ICU for months
TN STEMI- Plan for scaling up

Drugs for thrombolysis

CMCHIS Streptokinase used at
Creation of
Extending special STEMI present Registry
packages to new HUBs Including Reteplase/
and SPOKEs Tenecteplase based on Quality
Thrombolysis the RePami study result Assurance
and cost-benefit analysis
Primary PCI in the EDL list in Creating
Pharmaco-invasive Government Hospitals
Thank you

Thank you

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