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National Roll-Out of Primary PCI in the UK: Where are we

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National Roll-Out of Primary PCI in the UK: Where are we

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    1. National Roll-Out of Primary PCI in the UK: Where are we? Jim McLenachan, National Clinical Lead for PPCI, NHS Improvement, England.

    2. Development of PPCI services MINAP data

    3. Total Lysis & PPCI (2005-2009) (MINAP Data)

    4. 6 month mortality for STEMI (MINAP Data 2005-7, patients <80 yrs)

    5. Cardiac Networks providing PPCI to > 60% of STEMI patients MINAP 2008-9 data NC LONDON NE LONDON NW LONDON SE LONDON SW LONDON BLACK COUNTRY COVENTRY + WARWICK (BIRMINGHAM) WEST YORKS

    6. Cardiac Networks providing PPCI to 30-60% of STEMI patients MINAP 2008-9 data BIRMINGHAM, SAND, SOLIHULL 57% NORTH OF ENGLAND 59% PENINSULA 21%

    7. Cardiac Networks providing PPCI to < 30% of STEMI patients MINAP 2008-9 data ANGLIA AGWS BEDS + HERT CHESHIRE DORSET EAST MIDLANDS ESSEX GR MANCHESTER HERTS + WORCESTER KENT LANCS + CUMBRIA NORTH OF ENGLAND NORTH TRENT N + E YORKS SHROPS AND STAFFS SOUTH CENTRAL SURREY SUSSEX

    8. Primary PCI in the UK Some common issues Myths about losing “excellent thrombolysis” Issues about call-to-balloon and door-to-balloon times (should there be any lysis?) 24/7 centres only or some non-24/7 centres?

    9. Primary PCI in the UK

    10. How are STEMI patients treated? MINAP 2008-9 data

    11. % CTN <120 mins (2001-2005) [MINAP Data - all lysis] 2008 is a part year. Not sure if fall is real, but it may be. Those having pre-hospital treatment – the low hanging fruit? – are excluded, of course2008 is a part year. Not sure if fall is real, but it may be. Those having pre-hospital treatment – the low hanging fruit? – are excluded, of course

    12. % DTN <30 mins (2000-2008) [MINAP Data - excludes PHT] 2008 is a part year. Not sure if fall is real, but it may be. Those having pre-hospital treatment – the low hanging fruit? – are excluded, of course2008 is a part year. Not sure if fall is real, but it may be. Those having pre-hospital treatment – the low hanging fruit? – are excluded, of course

    13. Primary PCI in the UK Some common issues Myths about “excellent thrombolysis” Call-to-balloon and door-to-balloon times (should there be any lysis?) 24/7 centres only or some non-24/7 centres?

    14. Primary PCI in the UK What should we measure? Call-to-balloon time Door-to-balloon time PCI-related delay

    15. Acceptable PCI-Related Time Delay Nallamothu 60 mins - inaccurate data Terkelsen 119 mins Boersma =120 mins Pinto 114 mins RIKS-HIA >>90 mins Vienna 138 mins ASSENT-4 >>102 mins

    18. % of all cases with DTB times <90 mins

    20. Median door to balloon times (MINAP Data) For this and the preceding slide Peter Ludman might argue that MINAP does not have all the data; nor does BCIS! But this is something both groups are committed to sorting outFor this and the preceding slide Peter Ludman might argue that MINAP does not have all the data; nor does BCIS! But this is something both groups are committed to sorting out

    21. Primary PCI in the UK Some common issues Myths about “excellent thrombolysis” Call-to-balloon and door-to-balloon times (should there be any lysis?) 24/7 centres only or some non-24/7 centres?

    22. PCI Mortality (stratified by syndrome)

    23. Hospital Mortality after PCI for patients without acute MI:

    24. Hospital Mortality after PCI for STEMI and NSTEMI patients:

    25. Primary PCI in the UK ...... More specific problems....

    26. Travel Times - William Harvey, Kent

    27. 97% PPCI COVERAGE: IS IT ACHIEVABLE?

    28. SUMMARY Primary PCI roll-out is happening! We need to keep quality on the agenda. The network (or SHA) approach is correct. Inter-Trust competition is damaging and obstructive. 97% PPCI rate by 2011 is a tall order.

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