Developing primary PCI as a national reperfusion strategy for patients with ST-elevation myocardial infarction: the UK experience

EuroIntervention. 2012 Aug:8 Suppl P:P99-107. doi: 10.4244/EIJV8SPA18.

Abstract

In 2004 in the United Kingdom (UK), the infrastructural and organisational changes required for implementation of primary PCI for treatment of STEMI were unclear, and the cost-effectiveness and sustainability of a changed reperfusion strategy had not been tested. In addition, any proposed change was to be made against the background of a previously successful in-hospital thrombolysis strategy, with plans for greater use of pre-hospital administration. A prospective study (the "National Infarct Angioplasty Project - NIAP") was set up to collect information on all patients presenting with STEMI in selected regions in the UK over a one year period (April 2005 - March 2006). The key findings from the NIAP project included that PPCI could be delivered within acceptable treatment times in a variety of geographical settings and that the shortest treatment times were achieved with direct admission to a PPCI-capable cardiac catheter laboratory. The transformation from a dominant lytic strategy to one of PPCI across the UK was achieved both swiftly and consistently with the help of 28 cardiac networks. By the second quarter of 2011, 94% of those STEMI patients in England who received reperfusion treatment were being treated by PPCI compared with 46% during the third quarter of 2008.

MeSH terms

  • Delivery of Health Care, Integrated / organization & administration*
  • Delivery of Health Care, Integrated / standards
  • Health Policy
  • Health Promotion
  • Health Services Accessibility / organization & administration*
  • Health Services Accessibility / standards
  • Hospital Planning / organization & administration*
  • Hospital Planning / standards
  • Humans
  • Models, Organizational
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / therapy*
  • Organizational Objectives
  • Percutaneous Coronary Intervention* / standards
  • Policy Making
  • Practice Guidelines as Topic
  • Program Development
  • Program Evaluation
  • Quality Improvement / organization & administration
  • Quality Indicators, Health Care / organization & administration
  • Registries
  • State Medicine / organization & administration*
  • State Medicine / standards
  • Thrombolytic Therapy
  • Time Factors
  • Time-to-Treatment / organization & administration
  • Treatment Outcome
  • United Kingdom