National Angioplasty Audit - 2010

The number of PCIs in the UK was 1,345 per million population (pmp). These numbers remain 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.

There has been an increase in PCI activity in all the UK countries. Wales still has the lowest rate at 1200 pmp compared with the highest in Northern Ireland at 1704 pmp.

For the past 4 years the rate of increase in overall number of PCI procedures performed remains at the lowest level since records began in 1992, at under 5%.

The rate of primary PCI (to treat ST elevation MI in place of thrombolysis) continues to rise, and reached 221 pmp in 2009. This treatment option was provided 24/7 by 56 of the 88 NHS PCI centres.

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 (95 per cent), suggesting that this aspect of good practice is being met.

Following concerns about the safety of drug eluting stents in September 2006, there was a fall in their use to 55 per cent across the UK. Data from 2009 suggest an increase in their use now that safety issues are better understood, and are not dissimilar from what might be predicted from the National Institute for Health and Clinical Excellence (NICE) updated guidelines. Nevertheless there are large differences in the rate of DES use in the different UK countries.

The use of the radial artery for access has increased progressively from 10% in 2004 to 43% in 2009. This audit analysis supports the literature demonstrating a lower complication rate when PCI is performed via their radial artery, with approximately a halving of access site related complications.

The overall rate of death before discharge from hospital following PCI has gradually risen over the past few years. This is due to a change in case mix. There has been no evidence of a change in the outcomes when patients in similar clinical presentations are compared. For stable elective patients, in hospital mortality is less than 0.15%, for patients with unstable angina or NSTEMI, the in hospital mortality is less than 0.6 per cent. For patients with STEMI the mortality is higher at about 4 per cent.

National and International guidelines recommend that in the emergency treatment of patients with ST elevation MI, angioplasty treatment should be performed within 90 minutes of arrival of the patient at the angioplasty site.

(DTB time), and within 150 minutes of a patient's call for help (CTB time). The data for units performing PPCI for STEMI are presented as funnel plots. A DTB < 90 min was achieved in 87.3%, and CTB < 150 min in 75.3% of cases. This compares very favourably with international statistics.

Patients who need to be transferred between hospitals for primary PCI had longer delays than those admitted direct to a PCI centre.