The Southern Indian state of Kerala has served as a model health delivery system for the rest of India, with the highest life expectancy rates among the Indian states. While cardiovascular diseases are the leading cause of mortality in India, the proportion of population dying from cardiovascular diseases is even higher in Kerala, with cardiovascular mortality rates exceeding those of industrialized nations. Population level interventions to effect primary prevention of cardiovascular diseases are imminently required to achieve sustainable reduction in the burden of cardiovascular diseases. There is a high prevalence of conventional cardiovascular risk factors including diabetes, hypertension, dyslipidemia and central obesity in Kerala. When seen in the context of a projected increase in the prevalence of diabetes in India over the next few decades, an alarming increase in the incidence of cardiovascular diseases can be expected. Acute coronary syndromes especially ST elevation myocardial infarction (STEMI) continues to be among one of the leading cause of cardiovascular mortality in Kerala. In order to reduce mortality and improve long-term outcomes following STEMI it is essential to develop systems of care to facilitate rapid reperfusion in these patients, using appropriate pharmacologic and interventional therapies. Over the past five years the state of Kerala has witnessed a rapid expansion in the number of percutaneous coronary intervention (PCI)-capable hospitals which can be designated as receiving centres for STEMI patients. With 71 cardiac catheterization laboratories in the state of Kerala, there is one cardiac catheterization laboratory available per 470,000 population, thereby substantially increasing the numbers of patients who potentially have timely access to cardiac catheterization services. The rates of primary PCI for STEMI have shown only marginalimprovement from 8.0% in the CREATE registry to 12.9% in the Kerala ACS registry (2007-2009). However, contemporary anecdotal evidence points out to more than 80% primary PCI rates for STEMI, at many PCI-capable centres in Kerala. We believe that the rapid expansion of cardiac catheterization services in Kerala offers a unique opportunity to assess the impact of this health infrastructure expansion on STEMI mortality and outcomes.

One of the objectives of the PARK is to ascertain if patients presenting to PCI-capable hospitals in Kerala have a significant improvement in mortality and major adverse cardiovascular events, compared to patients enrolled in the Kerala ACS registry and CREATE registry. The PARK findings will help in analysing how the STEMI cardiac catheterization services and adjunctive pharmacotherapy fare in comparison to current standards (ACC/AHA guidelines).