The National Infarct Angioplasty Project: UK experience and subsequent developments

Abstract

The UK had previously established a comprehensive strategy for in-hospital nurse-led thrombolysis for patients with ST-elevation myocardial infarction, with a growing use of pre-hospital thrombolysis by paramedical staff in the ambulance services. The National Infarct Angioplasty Project was sponsored by the government and examined the introduction of primary percutaneous coronary angioplasty (PPCI) in a variety of urban, rural and mixed communities. The project found that PPCI could be delivered within acceptable timelines, would be cost-effective, and could be delivered to the majority of the population. A project was therefore undertaken in England to transform services. There has been a rapid change and by 2012/13 over 95% of eligible patients received PPCI. Survival of patients with STEMI has improved over time and length of stay in hospital halved. However, nearly a quarter of STEMI patients do not receive reperfusion therapy (often because of late presentation) and additional work is needed to minimise delays to treatment. There are unexplained differences between regions in numbers of PPCI procedures per million population, and there is also variance between centres in the proportion of patients who are in shock or on a ventilator. Additional research is needed to ensure a consistent approach for these sick patients, who might have the most to gain from early treatment. The national audit programmes have been instrumental in measuring the changes in strategies, monitoring performance and highlighting the associated improvements in outcomes. A new risk model is being developed to allow a more comprehensive comparison of outcomes in different hospitals.

Cardiac audit, data and registries: evolution of a national programme

“…NICOR data were drivers of the National Infarct Angioplasty Pilot Project (2004–2008), which influenced the government policy decision to recommend primary angioplasty as the default revascularisation treatment for patients with STEMI 58. NICOR data have also been important in deriving performance indicators to assist healthcare commissioners.…”

Clinical outcomes of patients undergoing primary percutaneous coronary intervention for acute myocardial infarction requiring the intensive care unit

“…In recent years, the widespread recognition of primary percutaneous coronary intervention (PPCI) as an evidence-based treatment strategy that can improve outcomes has led to both an increase in PPCI volume and a reduction in hospital mortality associated with STEMI [ 2 , 3 ]. A major driver to facilitate this has been the creation and implementation of organised PPCI networks that are able to triage and deliver patients directly to centres able to routinely provide this service both in- and out-of-hours [ 4 , 5 ]. Patients are subsequently generally cared for in a coronary-care unit (CCU), which has been shown to reduce mortality [ 6 ].…”

“…The National Infarct Angioplasty Project has demonstrated the benefits of PPCI over thrombolysis for treatment of STEMI patients [ 7 ] and has led to the creation of PPCI centres across England. By 2013, some regions demonstrated that more than 95% of patients treated for STEMI received PPCI, compared with only 30% in the third quarter of 2008 [ 5 ].…”

The design and rationale of the primary angioplasty registry of Kerala

“…There was rapid change and, by 2012–2013, over 95% of eligible patients received primary PCI. 22 Such regional audits will play a decisive role in measuring changes in strategies, monitoring performance and highlighting the associated improvements in outcomes. 22 …”