West Hertfordshire Primary Angioplasty Service Masood Khan.

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Presentation transcript:

West Hertfordshire Primary Angioplasty Service Masood Khan

Drug therapy thrombolytic PCI Pathology of Myocardial Infarction

Patients with TIMI 3 flow Lange, R. A. et al. NEJM 1996;335:

Percutaneous Coronary Intervention (PCI)

PPCI - example

Primary PCI vs Thrombolysis Short-term mortality (%) PCI Lytic PCI Lytic Meta-analysis 23 trials 7739 patients All Patients No shock patients p= % CI 0.73 [0.06,0.86] p= % 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 hrs >6 hrs p=0.04 for difference between 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-2 Results at 30 days P=0.35 P< P=0.15 P= patients - trial stopped early. Anderson et al. NEJM. 2003:349: day outcomes (%)

PPCI in the UK MINAP Report 2008, RCP

PPCI in the UK MINAP Report 2008, RCP

Local PPCI Centres

Local PPCI Centres – the future

Primary PCI pathway ECG performed in ambulance ST elevationWGH A&E 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 No Yes

Door to balloon times 56 PPCI centres in UK, HospitalMedian door to balloon time (min) PPCI within 90min (%) 1. Harefield Hospital Hammersmith Hospital Freeman Hospital Hemel Hempstead Hospital 3595

Thank you