National Angioplasty Audit - 2007

The number of PCIs in the UK was 1,216 per million population (pmp). These numbers are less than in most other developed European countries. The number of angiograms and PCI procedures are also less than that recommended by the British Cardiovascular Society (BCS), but both exceed the numbers expected by the National Service Framework (NSF) for Coronary Heart Disease. For PCIs, the NSF target in 2000 was 750 (pmp), and the BCS 2003 target was 1,400 pmp, with expectations that the level might need to be 2-3,000 pmp.

The National Institute for Health and Clinical Excellence (NICE) recommend that "Stents should be used routinely where PCI is the clinically appropriate procedure for patients with either stable or unstable angina or with acute myocardial infarction". The great majority of procedures do now involve stent insertion (94 per cent), suggesting that this aspect of good practiceis being met.

61 per cent of the stents inserted in England, and 80 per cent of those in Wales, were coated with a drug designed to pass into the wall of the artery to improve the longer term success rates of the procedure (these coated stents are called drugeluting stents). The National Institute for Health and Clinical Excellence (NICE) recommend that "A drug-eluting stent should be used if the person has angina, and the inside diameter of the artery is less than 3 mm across, or the narrowed area is more than 15 mm long." Research suggests that compliance with the NICE guidance on use of such stents would result in about 76 per cent of patients being treated with a drug eluting stent, which is in keeping with the rates observed in this audit and suggests that recommended practice is being followed.

National and International guidelines recommend that in the emergency treatment of patients with ST elevation myocardial infarction (STEMI), angioplasty treatment should be performed within 90 minutes of arrival of the patient at the angioplasty site. For the first time the CCAD data were used to measure unit's ability to deliver treatment in this time frame. For almost every unit providing a full time service, the median door to balloon times less than 90 minutes.

The overall rate of death before discharge from hospital following PCI has remained fairly stable over recent years at around 0.5-1 per cent, and there has been a marked fall in the need for emergency coronary artery bypass surgery to try to solve a PCI complication (in 2006, this occurred in less than 0.1 per cent of all procedures).

The risk of in-hospital death for emergency patients varies according to clinical syndrome. For patients with unstable angina or non ST elevation myocardial infarction (NSTEMI), the in hospital mortality is less than 1 per cent. For patients with STEMI, the mortality is higher at about 5 per cent.