West Hertfordshire Primary Angioplasty Service Masood Khan.
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Transcript of West Hertfordshire Primary Angioplasty Service Masood Khan.
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