1. West Hertfordshire Primary Angioplasty Service Masood Khan

2. Drug therapy thrombolytic PCI Pathology of Myocardial Infarction

3. Patients with TIMI 3 flow Lange, R. A. et al. NEJM 1996;335:1311-1312

4. Percutaneous Coronary Intervention (PCI)

5. PPCI - example

7. Primary PCI vs Thrombolysis Short-term mortality (%) PCI Lytic PCI Lytic Meta-analysis 23 trials 7739 patients All Patients No shock patients p=0.002 95% CI 0.73 [0.06,0.86] p=0.003 95% CI 0.70 [0.58,0.85] Lancet 2003;361:13-20

8. Mortality at 30 days and one year by time to PCI treatment Time to treatment 30-day mortality (%) 1-yr mortality (%) <3 hrs0.92.6 3-6 hrs2.24.3 >6 hrs2.24.8 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

9. DANAMI-2 Results at 30 days P=0.35 P<0.0001 P=0.15 P=0.0003 1572 patients - trial stopped early. Anderson et al. NEJM. 2003:349:733 30-day outcomes (%)

10. PPCI in the UK MINAP Report 2008, RCP

11. PPCI in the UK MINAP Report 2008, RCP

12. Local PPCI Centres www.streetmap.co.uk

13. Local PPCI Centres – the future www.streetmap.co.uk

14. 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

15. Door to balloon times 56 PPCI centres in UK, 2007-8 HospitalMedian door to balloon time (min) PPCI within 90min (%) 1. Harefield Hospital 23100 2. Hammersmith Hospital 3091 3. Freeman Hospital 3091 4. Hemel Hempstead Hospital 3595

16. Thank you