Audit finds big improvement in treatment of myocardial infarction

BMJ 2009; 338 doi: (Published 24 June 2009) Cite this as: BMJ 2009;338:b2557
  1. Jacqui Wise
  1. 1London

    By the end of the year use of primary angioplasty to treat myocardial infarction will exceed that of thrombolytic treatment for the first time in England, says the eighth report of the myocardial ischaemia national audit project (MINAP).

    In October 2008 the Department of Health recommended that primary angioplasty should take over from thrombolytic drugs as first line treatment for myocardial infarction (BMJ 2008;337:a2185, doi:10.1136/bmj.a2185). The aim is for coverage of 97% of patients by 2011. Primary angioplasty is associated with less mortality and has better longer term outcomes than thrombolysis, provided that the procedure is carried out within three hours of the onset of symptoms.

    MINAP collected data from all hospitals and ambulance services in England and Wales that provide care for patients with a suspected heart attack. It found that in England 7351 patients were treated with primary angioplasty in 2008-9, representing 47% of all those receiving treatment (up from 27% in 2007-8).

    In Wales, 118 patients were treated with primary angioplasty in 2008-9, up from 42 in 2007-8.

    Roger Boyle, England’s clinical director for heart disease and stroke, praised the NHS’s achievement. He said, “Primary angioplasty is the international gold standard of heart attack treatment. We expect still higher numbers of heart attack patients to be treated with primary angioplasty as the NHS continues the roll-out of specialist services this year.”

    Primary angioplasty is carried out in a catheter laboratory, and ideally the service should be available 24 hours a day, seven days a week and should comprise a cardiologist, nurses, and cardiac technicians, with access to advanced radiological facilities. Only larger, well staffed hospitals are able to provide this.

    The report, which was commissioned by the Healthcare Quality Improvement Partnership, found that three of 28 English cardiac networks and one of the three Welsh cardiac networks still have very restricted access to primary angioplasty services.

    The number of hospitals that have performed primary angioplasty rose from 54 to 66 in the past year, although 14 of these hospitals performed fewer than 10. In Wales only two hospitals perform primary angioplasty.

    Clive Weston, MINAP’s associate director, said, “The provision of a primary angioplasty service demands new patterns of working by ambulance services and groups of hospitals, with patients being admitted to a smaller number of more specialised hospitals.”

    He added: “We need to continue to monitor the management of heart attack to show that the former high quality system of care, mainly based upon thrombolytic drug treatment, is replaced by an equally excellent system using primary angioplasty as the preferred therapy.”

    Although the recommended first line treatment is primary angioplasty, where that is not yet available it is important that thrombolytic treatment not be delayed. The report found that performance in England in this area was broadly unchanged, with 71% of hospitals and their associated ambulance services reaching the target of delivery of thrombolysis within 60 minutes of the call for professional help. In Wales there had been improvement in the speed of treatment on the patient’s arrival at hospital, but more work needed to be done to improve the use of thrombolytic treatment before arrival at the hospital, the report said.


    Cite this as: BMJ 2009;338:b2557


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