UK Audit Suggests Interventional Cardiology Revolution Has Occurred

In short

An article on Heartwire (theheart.org) points out that primary percutaneous Coronary Intervention (PCI) is now the preferred treatment for ST-elevation myocardial infarction (STEMI) in the UK. The implication of new audit figures is that the investment in cardiology seen in the UK in recent years has increased angioplasty access dramatically, with so-called Door-To-Balloon times now on a par with the U.S.

Background

The total number of PCIs performed in the U.K.  has doubled in the past decade, according to new audit figures. The audit was performed by the National Institute for Cardiovascular Outcomes Research (NICOR) and shows that there has been a year-on-year increase in PCIs in the UK over the past 10 years: from 44 193 procedures in 2002 to more than 88 000 in the calendar year 2011.

This has been achieved by an expansion of both the number of PCI centers and increased activity within existing centers: there are 117 PCI centers in the UK, of which 99 are National Health Service.

Physician comments

The audit covers all units and all patients treated; they participate under a professional obligation rather than any statutory requirement, leader of the audit, Dr Peter Ludman (Queen Elizabeth Hospital, Birmingham, UK), explained to heartwire.

“We’ve been playing catch-up. We were very far behind many European countries, and we have clearly invested in cardiology effectively and increased the access of angioplasty to a lot of people. We’ve also rolled out primary angioplasty as the dominant strategy for STEMI,” he commented.

Ludman thinks the door-to-balloon (DTB) times and call-to-balloon times for primary angioplasty in the audit “are pretty impressive, certainly compared with some of the North American data that we have seen.” DTB <90 minutes, as per guidelines, were achieved in 92% of cases, and call-to-balloon times <150 minutes were achieved in 80% of cases.

Radial access preferred route

Other key findings include the fact that the radial artery is now the leading access route for PCI, with more than 58% of procedures in the UK in 2011 employing radial access, up from 10% in 2004.

Stent use comparable with other countries

The report also shows a similar use of stents and drug-eluting stents to other countries with the great majority of PCI procedures now employing stents (92%).

The full article can be found here.

Source: theheart.org