PCI Models: Gloucestershire
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PCI Models: Gloucestershire
Nick WestConsultant Cardiologist
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MY CONFLICTSOF INTEREST ARE:
Advisory Board: Nycomed, Astrazeneca, Schering-Plough
Speaker Fees: Nycomed, Astrazeneca, Schering Plough, MSD
Sponsorship: Boston Scientific, Nycomed, Medtronic, Abbott Vascular
Research Grants: Bristol-Myers Squibb
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Glos Hosps NHS Foundation Trust
• 650,000 population• 2 DGHs• 2 Cath labs• 3 Interventionalists
• Remote from Tertiary centres
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Who should go to a surgical centre?
Viewpoints: Patients Trusts Cardiologists
A local service
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Out of countyIn-county
PCI in Gloucestershire:Inpatient vs. Elective work.
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Possible issues
Out-of-hours/on-callSpecialist techniques/devices‘High risk’ casesResearch studies
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Out of hours/on-call
Can your service offer PCI 24/7?Are you geared up for emergencies?How many interventionalists are there?Is there an on-call rota?Do the rest of the cath lab staff want this?Is it cost-effective?
Network solutions
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What is ‘high risk’?
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Out of countyUrgent PCIElective PCI
PCI in Gloucestershire:Inpatient vs. Elective work.
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How do we measure up?
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Grayson et al. Heart 2006; 92: 658-663
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Research Studies
Should offsite centres be allowed to join in?
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E-5 Registry: the ‘Real World’E-5 Registry: the ‘Real World’
Final UK recruitment:Final UK recruitment:
Cheltenham GeneralCheltenham General 100 100Leeds GeneralLeeds General 6565Royal Victoria, BelfastRoyal Victoria, Belfast 5151St. Georges, London St. Georges, London 4646James Cook, M’boro James Cook, M’boro 3636QE, BirminghamQE, Birmingham 3535Derriford, Plymouth Derriford, Plymouth 1818Barts, LondonBarts, London 1414Nottingham City Nottingham City 1313Walsgrave, Coventry Walsgrave, Coventry 1313London Chest London Chest 1212
PC Biomimetic polymerPC Biomimetic polymerReduced platelet depositionReduced platelet deposition
Rapid and complete drug deliveryRapid and complete drug deliveryHighly lipophillic limus analogueHighly lipophillic limus analogue
Noninflammatory responseNoninflammatory responseand rapid endothelializationand rapid endothelialization**
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Possible issues
Out-of-hours/on-callSpecialist techniques/devices‘High risk’ casesResearch studies
?
X
X
X
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Summary
Few good arguments to limit offsite work
Can we all live together happily ever after?
Acknowledgements
Rafe Chamberlain-WebberZafar KhanAll cath lab staff at CGH