Adult Percutaneous Coronary Interventions (Angioplasty audit)

Obstructions in the heart arteries that supply the heart muscle with blood can lead to exertion-induced chest pain (called angina).  If these symptoms cannot be controlled by medical treatment, then patients can often be helped by methods to improve blood flow, overcoming the obstructions. There are two techniques:  percutaneous coronary intervention (PCI) (also 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 by inserting  a thin tube called a ‘guide catheter’ 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). Complications are fewer if the wrist can be used.  Once the catheter is in place, equipment such as wires, balloons and stents are manipulated under X-ray guidance to treat the blockage (s).

Historically the decision around what size stents to use, the preparation of the blockage and the decision around whether the stent result was optimal was made using the native eye looking at x-ray images. In more contemporary practice newer imaging technology can be used including devices that use light (OCT) or sound waves (IVUS), to more accurately examine coronary arteries, particularly in relation to the characteristics of the narrowing and size of the vessel. It allows more accurate treatment of the blockages and sizing of the stents, and whether the stents have been expanded adequately, the whole narrowing has been covered and that there are no local vessel complications from insertion of the stent. Such imaging technology has been show to improve outcomes following these procedures in patients, particularly in complex cases.

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 . A more detailed analysis of the PCI audit data is available in two forms:

The PCI audit slide deck

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.

 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 this 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.