Expansion in the use of Percutaneous Coronary Intervention (PCI) – the minimally invasive surgery performed on heart patients instead of using drugs – is seeing more patients with acute coronary syndromes treated more quickly, according to the latest National Audit of PCI (covering 2012).
PCI mechanically improves blood flow to the heart using stents and can be used to relieve the symptoms of angina, prevent and treat heart attacks. When used to treat heart attack patients, the procedure is called primary PCI.
Commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme*, the National Audit of PCI is clinically led by the British Cardiovascular Intervention Society and managed by the National Institute for Cardiovascular Outcomes Research.
Key findings include:
- The number of PCIs performed in the UK has more than doubled over the last decade. In 2002, 44,913 PCI procedures were performed compared to over 92,000 performed in 2012. This has been achieved by an expansion of both the number of PCI centres and activity within existing centres.
- Primary PCI is now the preferred treatment for heart attack patients instead of traditional 'clot busting' drugs. The percentage of patients receiving it has more than doubled since 2006.
- There has been a year on year improvement in treating patients within target times. In 2012 86% of all patients were treated within 150 minutes of calling for professional help and 90% treated within 90 minutes of arriving at the PCI centre. This compares very favourably with international data.
- Patients who need to be transferred between hospitals for primary PCI had longer delays to treatment than patients admitted directly to a PCI centre. Transfers delayed treatment by about 40 minutes.
- There has been a continued increase in the use of the radial artery instead of the femoral for access, and this may be one of the factors responsible for driving down complication rates.
Whilst overall access to PCI and primary PCI has improved there remain large differences between the countries of the United Kingdom.
For overall PCI rates per million population (pmp), Wales has the lowest rates at 1,363 pmp and Northern Ireland the highest (1,917). The PCI activity for England is 1,423. For primary PCI, England had the highest rates at 390 and Northern Ireland the lowest (180). While there are differences, steps have been taken to increase provision in each of the countries. The most noticeable differences was in Wales where the rates of primary PCI increased by over 70% to ensure more patients had access to primary PCI.
The report collected data on 92,445 PCI procedures from 97 NHS PCI centres and 7 private hospitals between January and December 2012.
Peter Ludman, Consultant Cardiologist and Clinical Lead of the national audit said: "One of the key steps to maintaining and improving high quality treatment is measuring what you are doing. It is a great tribute to all PCI centres in the UK that they are dedicated to providing detailed information about the procedures they carry out, so that the information can be collated and analysed at a national level. These data provide considerable insight into the practice of PCI, showing not only how practice is evolving over the years, but also how different units compare with each other and how the UK compares with other countries".