Expanded PCI improving treatment times in U.K.

Expanding PCI services in the U.K. among patients with acute coronary syndromes has led to faster treatment times, according to the British Cardiovascular Intervention Society’s National Audit of PCI published online on Jan. 30.

The current version of the audit, which included data from all of 2012 from across the U.K., reported that among STEMI patients, the call-to-balloon time was less than 150 minutes in 86 percent of cases and the door-to-balloon time was less than 90 minutes in 90 percent of cases. Among non-STEMI patients, 66 percent were treated within 96 hours with coronary angiography and PCI as indicated. These times are consistent with international standards.

However, transferring patients to other hospitals for primary PCI added about 40 minutes to those treatment times, which is an improvement over the 2011 delay of 50 minutes.

The audit also reported that there were more than twice as many PCIs performed in 2012 (more than 92,000) compared with 2002 (44,913). A greater number of PCI centers as well as procedures performed within existing facilities accounted for the increase. Additionally, primary PCI is now the preferred treatment for STEMI, which also contributed to the increase in procedures.

The use of drug-eluting stents also changed in 2012, increasing to 76.2 percent of cases. In 2006, that number was 55 percent due to safety issues, but as those issues were better understood, the stents became more widely used. However, patterns of use vary throughout the U.K.

Safety was also an issue related to PCI access. In 2004, only 10 percent of PCIs accessed the radial artery, but as evidence evolved supporting lower complication using this route, radial access increased to more than 65 percent of cases in 2012.

Inhospital mortality also increased over the past few years. In 2012, the inhospital mortality rate was 1.9 percent, more than double the 2007 rate of 0.89 percent. This trend, the authors noted, could be due to better data entry or an increased number of sicker patients undergoing PCI.