MMyocardialyocardialIIschaemiaschaemiaNNationalational AAudituditPProjectroject

Are we replacing good fibrinolytic treatment with poor primary PCI?

John Birkhead

who has NO CONFLICT OF INTEREST

ADVANCED CARDIOVASCULAR INTERVENTION 2010

MMyocardialyocardialIIschaemiaschaemiaNNationalational AAudituditPProjectroject

Primary PCI ; dominant reperfusion therapy in England & Wales

%

MMyocardialyocardialIIschaemiaschaemiaNNationalational AAudituditPProjectroject

Access to pPCI by hospital Q1 – 2 2009

93

No pPCI 100% pPCI

Hospitals in E&W; n = 223

MMyocardialyocardialIIschaemiaschaemiaNNationalational AAudituditPProjectroject

30 day mortality (95% CI): thrombolytic treatment and primary angioplasty for STE MI

9.5%

4.5%

MMyocardialyocardialIIschaemiaschaemiaNNationalational AAudituditPProjectroject

Use of thrombolytic treatment 2007-9

For admission diagnosis STE MI:

• >70 % had lysis < 60 min after call

• 28% pre-hospital (2007)

• door to needle 19 min (IQR 13, 26)

• >80% had lysis (2003-4)

• >60% had angio (2009)

Interval from onset of symptoms to treatment;~ admission diagnosis STE MI

Median 130 min

MMyocardialyocardialIIschaemiaschaemiaNNationalational AAudituditPProjectroject

30 day mortality; lysis & early angio or rescue vs pPCI

MINAP 2007-9

5%

4.4%4

MMyocardialyocardialIIschaemiaschaemiaNNationalational AAudituditPProjectroject

Median delays in provision of pPCI

Onset – needle 147 minutes193 min

MMyocardialyocardialIIschaemiaschaemiaNNationalational AAudituditPProjectroject

MINAP data

Reperfusion Rx for STEMI (England & Wales) 2003-9

33% too late16% ECG ineligible17% elective11% bleeding risk0.5% hypertension

MMyocardialyocardialIIschaemiaschaemiaNNationalational AAudituditPProjectroject

Distribution by ageband of reperfusion treatment2007-9

MINAP data

MMyocardialyocardialIIschaemiaschaemiaNNationalational AAudituditPProjectroject

Comparative use of reperfusion treatment by ageband 2007-9

MMyocardialyocardialIIschaemiaschaemiaNNationalational AAudituditPProjectroject

30 day mortality following lysis + rescue/early angio vs pPCI

MMyocardialyocardialIIschaemiaschaemiaNNationalational AAudituditPProjectroject

Are we replacing good fibrinolytic treatment with poor primary PCI?

Conclusions

Organisation: ?+Equity of access ? -

MMyocardialyocardialIIschaemiaschaemiaNNationalational AAudituditPProjectroject