Pilot Study - Heart-attack Patients Fast-tracked Into Cardiac Catheter Lab For Treatment

Main Category: Cardiovascular / Cardiology
Also Included In: Heart Disease;  Clinical Trials / Drug Trials
Article Date: 22 Oct 2008 - 5:00 PDT

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A pilot study of Primary Percutaneous Coronary Intervention (PPCI), where heart attack patients are fast-tracked into the cardiac catheter lab for treatment, has been extremely successful at the Oxford Radcliffe Hospitals, England.

In collaboration with the South Central Ambulance Service, the Oxford Radcliffe Hospitals' Cardiac Department has been piloting immediate access, 24/7, to PPCI, successfully delivered by a multidisciplinary team. Those patients with a suspected heart attack are first assessed by paramedics who take an ECG (electrocardiogram) tracing to identify if they are suitable for PPCI then transmit it by telemetry to the Coronary Care Unit for confirmation. The patient then bypasses the Emergency Department and goes straight to the cardiac catheter lab for treatment by means of angioplasty. Results of the project in the last year, the largest non-urban service in the UK, have been extremely positive.

By providing PPCI, Oxford is already on track to meet new recommendations which were announced on Monday, by the Department of Health, at joint meetings in Oxford and Manchester. The report from the National Infarct Angioplasty Project (NIAP) will recommend that angioplasty becomes the nation's first line of treatment for heart attacks, saving hundreds of lives each year. The NIAP study has concluded that it is both feasible and cost-effective to offer angioplasty as an emergency treatment for 97% of the population of England.

Currently, thrombolysis, the injection of life saving clot busting drugs, is the most common treatment for heart attack patients. Primary angioplasty is widely believed to provide better outcomes, provided that it can be delivered quickly. Angioplasty is the procedure of inserting, then inflating, a small balloon in the blocked coronary artery, leaving a rigid support (or stent) to scaffold the artery and restore blood flow to normal.

Clinical evidence shows that using angioplasty as the main treatment for heart attack patients will:

- save around 240 more lives per year
- reduce complications from treatment of heart attack
- reduce reoccurrence of heart attack
- prevent around 260 strokes per year
- decrease the length of stay in hospital for primary angioplasty patients.

The NIAP report concludes that 97% of people in England can receive the treatment within acceptable treatment times (120 minutes from call for professional help to treatment). Those who cannot get treatment on time, or are unable to have angioplasty for health reasons, will still be treated with early thrombolysis.

National Clinical Director for Heart Disease and Stroke, Roger Boyle said:

"As well as providing further evidence of the efficacy of angioplasty, this report shows that a primary angioplasty can be offered to heart attack patients in almost all parts of the country. This is a very positive conclusion in terms of improving outcomes for heart attack patients and ultimately saving lives."

Oxford Radcliffe Hospitals Consultant Cardiologist, Dr Bernard Prendergast said:

"The national report provides very welcome support for the PPCI project in Oxford which has already been in place for over a year. We now hope to extend this life-saving treatment to a larger number of patients and establish Oxford as a regional heart attack centre for a wider geographical area. The new £29m Oxford Heart Centre, scheduled to open in 2009 on the John Radcliffe site, will help us to achieve this."

The report is available online at: http://www.dh.gov.uk.

The report's conclusions draw from findings involving over two thousand patients collected over three years from seven pilots (ten sites) in different service models and geographical locations in England.

NIAP is an observational study set up by the Department of Health in collaboration with the British Cardiovascular Society (BCS) and British Cardiovascular Intervention Society (BCIS).

The National Service Framework for CHD (March 2000) set out a ten year framework for action to prevent disease, tackle inequalities, save more lives, and improve the quality of life for people with heart disease. An estimated 33,000 lives were saved in 2007 compared to 1996.

Inequalities in the death rate from heart disease, stroke and related diseases among the under 75s have been narrowing for the past eight years. The gap between the England average and the fifth of areas with the worst health deprivation scores has reduced by 32% since 1995-7.

Thrombolysis is a treatment for unblocking arteries with clot busting drugs.

Primary angioplasty, also known as primary percutaneous coronary intervention or PPCI, involves inserting, then inflating, a small balloon in the blocked coronary artery, leaving a rigid support, or 'stent', which restores blood flow. This procedure is carried out in a cardiac catheter laboratory.

There are different models of delivering primary angioplasty, for example, some patients are assessed first in the nearest hospital's A&E then transferred to the catheter lab in a primary angioplasty centre. Some are assessed by ambulance crew and taken to a primary angioplasty centre where they arrive in A&E before transferring to the catheter lab. The model which achieves the fastest times is assessment by ambulance crew and transfer directly to a catheter lab in a primary angioplasty centre, bypassing local hospitals and A&E.

110,000 people every year in England have a heart attack.

Oxford Radcliffe Hospitals NHS Trust