Developing primary PCI as a national reperfusion strategy for patients with ST-elevation myocardial infarction: the UK experience.
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.
NHS Improvement Programme, United Kingdom, and Leeds General Infirmary, Leeds, United Kingdom.
James M
JM
McLenachan
Huon H
HH
Gray
Mark A
MA
de Belder
Peter F
PF
Ludman
David
D
Cunningham
John
J
Birkhead
D019033:Delivery of Health Care, Integrated / Q000458:organization & administration* / Q000592:standards; D006291:Health Policy; D006293:Health Promotion; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000592:standards; D006752:Hospital Planning / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D017146:Models, Organizational; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D009937:Organizational Objectives; D062645:Percutaneous Coronary Intervention / Q000592:standards; D011050:Policy Making; D017410:Practice Guidelines as Topic; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration; D019984:Quality Indicators, Health Care / Q000458:organization & administration; D012042:Registries; D013222:State Medicine / Q000458:organization & administration* / Q000592:standards; D015912:Thrombolytic Therapy; D013997:Time Factors; D061665:Time-to-Treatment / Q000458:organization & administration; D016896:Treatment Outcome; D006113:United Kingdom