Transcript The Primary Angioplasty Service

West Hertfordshire Primary
Angioplasty Service
Masood Khan
Pathology of Myocardial
Infarction
PCI
Drug therapy
thrombolytic
Patients with TIMI 3 flow
Lange, R. A. et al. NEJM 1996;335:1311-1312
Percutaneous Coronary
Intervention (PCI)
PPCI - example
PPCI - example
Primary PCI vs Thrombolysis
10
p=0.002
95% CI 0.73 [0.06,0.86]
p=0.003
95% CI 0.70 [0.58,0.85]
Short-term mortality (%)
9.3
8
6
7.4
7.0
5.4
4
2
0
PCI Lytic
All Patients
Lancet 2003;361:13-20
PCI Lytic
No shock patients
•Meta-analysis
•23 trials
•7739 patients
Time to treatment is vital:
symptoms to balloon
Mortality at 30 days and one year by time to
PCI treatment
Time to
treatment
30-day
mortality
(%)
1-yr mortality
(%)
<3 hrs
0.9
2.6
3-6 hrs
2.2
4.3
>6 hrs
2.2
4.8
p=0.04 for difference between <3 hrs and >3 hrs for
both 30-day and one-yr mortality
Stuckey T. American College of Cardiology Scientific Sessions. Mar
31-Apr 2, 2003: Chicago, IL. Registry data
DANAMI-2
Results at 30 days
16
P=0.0003
30-day outcomes (%)
13.7
12
P=0.35
8
7.6
P<0.0001
6.6
8.0
7.4
P=0.15
4
1.6
2.0
1.0
0
Death
MI
1572 patients - trial stopped early.
Anderson et al. NEJM. 2003:349:733
CVA
Combined
PPCI in the UK
MINAP Report 2008, RCP
PPCI in the UK
MINAP Report 2008, RCP
Local PPCI Centres
www.streetmap.co.uk
Local PPCI Centres – the future
www.streetmap.co.uk
Primary PCI pathway
ECG performed
in ambulance
No
ST elevation
WGH A&E
Yes
Option 1
WGH cathlab
0900 – 1600,
Monday - Friday
Option 2
Harefield cathlab
when WGH
not available
Transfer to
cathlab or day
ward
Transfer to
Harefield by blue
light ambulance
Door to balloon times
56 PPCI centres in UK, 2007-8
Hospital
Median door to
balloon time (min)
PPCI within 90min
(%)
1. Harefield
Hospital
23
100
2. Hammersmith
Hospital
30
91
3. Freeman
Hospital
30
91
4. Hemel
Hempstead
Hospital
35
95
Thank you