West Hertfordshire Primary Angioplasty Service

Masood Khan

Drug therapythrombolytic

PCI

Pathology of Myocardial Infarction

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

Short

-term

mort

alit

y

(%)

PCIPCI LyticLytic PCIPCI LyticLytic

•Meta-analysis •23 trials•7739 patients

All Patients No shock patients

p=0.00295% CI 0.73 [0.06,0.86]

p=0.00395% CI 0.70 [0.58,0.85]

Lancet 2003;361:13-20

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

Time to treatment is vital:symptoms to balloon

DANAMI-2Results at 30 days

8.0

1.0

6.6

1.6

13.7

2.0

7.4

7.6

0

4

8

12

16

Death MI CVA Combined

P=0.35P<0.0001

P=0.15

P=0.0003

1572 patients - trial stopped early.

Anderson et al. NEJM. 2003:349:733

30-d

ay o

utco

mes

(%

)

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

ST elevation WGH A&E

Option 1 WGH cathlab0900 – 1600,

Monday - Friday

Option 2Harefield cathlab

when WGH not available

Transfer to cathlab or day ward

Transfer to Harefield by blue light ambulance

No

Yes

Door to balloon times56 PPCI centres in UK, 2007-8Hospital 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