Dr Martyn Thomas Kings College Hospital Primary angioplasty “A UK Experience” “The UK experience”

PAMI activity in the UK 2003/2004  Data source  2003 data available via BCIS audit  Recent E mail request for data on PAMI to all PCI centres  Returns from 20 centres………assumed they are the “active” centres????  Kings data……….stopped thrombolysis for casualty patients Sept 1 st 2003

UK Intervention Centres

PCI for STEMI Data from units reporting cath or hosp outcome 900 (20 Centres)

Primary PCI for STEMI 2003 data from 43 centres/2004 from 20 centres Total 633 procedures 2003/ 900 procedures Hammersmith K Beatt

Hospital Outcome 2003 Data from 22 centres Patients Rx for STEMI

UK activity 2004 Audit of UK centres……….20 replies  7 centres perform 24/7 primary angioplasty.  Nos from 20 centres 900.  Mortality 0-14%  Door to balloon: 27’-205’………(some could not return data!). (2 hrs =120minutes…..4 centres recorded times >120 minutes)  Length of stay: 3 days[3];4 days[6];5 days[3];6 days[2];7days[2]

 Echo day 3.  EF >40% discharge on day 3.  EF <40% refer to EP team, discharge planning of arrhythmia risk, discharge day 5. Developed discharge protocol KCH

Timings  Time/timing is important  PAMI and pre-hospital thrombolysis are NOT mutually exclusive  You must record data!!

Recent “guideline document” for UK Primary Angioplasty:….times!! As a general guide transfer of patients to a PCI centre should be considered if this can be achieved within 60’. As a general guide transfer of patients to a PCI centre should be considered if this can be achieved within 60’. It is recommended that the time from call for professional help to treatment with angioplasty (‘call to balloon’ time) is no more than three hours. It is recommended that the time from call for professional help to treatment with angioplasty (‘call to balloon’ time) is no more than three hours. There is little evidence to support angioplasty beyond 12 hours. Assuming there may be a 1-hour transfer time and up to 2-hour ‘door to balloon’ time it is recommended that, in general, patients presenting to ambulance staff (or in an Emergency Centre) more than 9 hours beyond the onset of their symptoms should not be considered for a primary angioplasty programme There is little evidence to support angioplasty beyond 12 hours. Assuming there may be a 1-hour transfer time and up to 2-hour ‘door to balloon’ time it is recommended that, in general, patients presenting to ambulance staff (or in an Emergency Centre) more than 9 hours beyond the onset of their symptoms should not be considered for a primary angioplasty programme

Kings Data: A UK experience  Do you have to get out of bed  (EWTD…………………job plan…….new contract!!)  Can you deliver…………times  What message from the data (record it!!) should you take away!!

Do you have to get out of bed: sadly YES!!

Record data So “system” issues Can be examined.

Onset of chest pain Arrival in A&E Balloon inflation/ restoration of flow 3hrs 18 mins 1hr 15 mins 4hrs 33mins Timing Most important Message for “us” May be public education

Conclusions  The UK is preparing…………numbers are still small.  WE now have to prove we can deliver!!  The exciting potential that the UK could be converted to “optimal” revascularisation for AMI.  Replacing optimal thrombolysis (MINAP) with suboptimal PCI would not be acceptable.  Collect data!!  For audit centres in the UK pilot……………the pressure is on……………..we have to deliver………….  This is a major opportunity to change the face of Rx of acute MI in the UK for years to come.