Adult Percutaneous Coronary Interventions (Angioplasty audit)
When obstructions in the heart arteries lead to exertion-induced chest pain (angina) that cannot be controlled by medical treatment, then patients may be helped by methods to improve blood flow. The two techniques are percutaneous coronary intervention (PCI) (often referred to as ‘angioplasty’) and coronary artery bypass grafting (CABG). With PCI, the obstructive fatty deposit is pushed aside by inflating a small balloon in the artery, and then a wire mesh (called a ‘stent’) is inserted to scaffold the arterial wall open. The procedure is performed using x-rays to visualise the arteries. The procedure is performed through a thin tube called a guide catheter that is passed into the body to the heart under local anaesthetic from either the top of the leg (using the femoral artery) or the wrist (using the radial artery). Recent research has shown that complications are fewer when the wrist is used.
In the early years of using angioplasty it was used mainly for patients with stable angina. However, over the last 20 years it has been used more and more to treat patients with acute coronary syndromes, and especially for patients with heart attacks.
The background for this audit has been described in the main aggregate audit report, to which you can return with this link. A more detailed analysis of the PCI audit data is available in two forms:
This is a pdf document of slides which contains detailed information about the structure of PCI provision in the UK, and about the appropriateness, process and outcomes from PCI. The current analysis and the analyses of previous year’s data are available for download from the British Cardiovascular Intervention Society web site at this address:
To accompany this, two interactive graphic reports are available, where the data can be filtered, manipulated and downloaded. The first shows the speed with which emergency PCI is provided by each UK PCI centre for the treatment of patients with acute ST elevation myocardial infarction. This is expressed as percentage of patients treated within 60 minutes of arriving at the PCI centre.
The second shows the percentage of patients treated using the radial artery for access (rather than the femoral artery). The background for this and reasons behind the switch from femoral to radial are described in the main summary report.
Clinical Outcomes Publication (COP)
Activity, case mix, data completeness and outcomes following PCI for every consultant PCI operator and every PCI centre are available at the following link.
These web pages provide some background about coronary heart disease and its treatment by interventional techniques. There are descriptions about the data collected to assess quality, and an explanation about each component of these data, and why they are relevant in the assessment of quality. There are sections explaining the way in which the assessments have been made including a description of the statistical methods. The analyses of every operator and centre follow, with a simple search interface. Both the strengths and the limitations of conclusions that can be drawn need to be understood. Clinicians may appear to have better or worse outcomes for a variety of reasons, many of which are unrelated to the individual operators and their teams.