Which ACS patients should undergo PCI in a DGH?

Andrew Bishop

Surgeon Commander N Fisher

troponinaemia

lottery

structures in thetribe

modernism

Which ACS patients should undergo PCI in a DGH?

.evidence based medicine

.eminence based medicine

.local, national, international, interplanetary etc guidelines

Which ACS patients should undergo PCI in a DGH?

postmodern cardiology

truth is the opinion of themost powerful group

loss of activityloss of material for teaching and researchloss of role

risk exposureoverworkdiversion from other important activity

Which ACS patients should undergo PCI in a DGH?

respite from workloaddevelopment of new competencies

increase in activitystreamlined clinical servicehigher calibre staff

Which ACS patients should undergo PCI in a DGH?

Which ACS patients should undergo PCI in a DGH?

Which ACS patients should undergo PCI in a DGH?

local is better than remotemore rapid access to treatmentcontinuity of care

less safe carelower quality care

No.(Centres)

Success PartialSuccess

RepeatPCI

CABG re-MI Death(Range)

PrimaryPTCA

352(21)

90%(56-100)

2.6 %(0-11)

1.4%(0-22)

0.9 %(0-11)

2.3 %(0-22)

4.3%(0-13)

SalvagePTCA

578(22)

86%(50-100)

2.4%(0-7.1)

1.0%(0-3.8)

0.5%(0-5)

1.0%(0-5)

3.8%(0-14)

Re-MIPTCA

258(19)

90%(50-100)

3.1%(0-18)

2.7%(0-14)

0.8%(0-13)

4.7%(0-18)

3.1%(0-50)

Shock 167(22)

59%(0-100)

7.8%(0-17)

2.4%(0-25)

2.0%(0-33)

0.6%(0-25)

35%(0-100)

No.(Centres)

Success PartialSuccess

RepeatPCI

CABG Re-MI

Death(Range)

Post MI UA 1796(22)

94%(86-100)

2.3%(0-6.9)

0.2%(0-2.9)

0.4%(0-4)

0.7%(0-2.9)

0.9%(0-3.4)

Post MIStable/+ETT

609(18)

92%(70-100)

1.7%(0-11)

0.8%(0-2.6)

0% 0.8%(0-6.7)

1.0%(0-6.4)

ALL MIPatients

3104(22)

90%(80-100)

2.8%(0-6.7)

0.9%(0-6.3)

0.6%(0-4.4)

1.4%(0-12.5)

3.7%(0-12.5)

No.(Centres)

Success PartialSuccess

RepeatPCI

CABG Q MI Death(Range)

Single VesUA

4553(26)

95%(78-99)

1.6%(0-5.7)

0.5%(0-2.6)

0.5%(0-11)

0.6%(0-3.5)

0.7%(0-11)

MultivesselUA

1387(26)

90%(76-100)

7.9%(0-22)

0.4%(0-2.4)

0.2%(0-2.2)

0.9%(0-20)

0.7%(0-40)

BCIS 2001 00 0 3

Safe angioplasty

Good angioplasty

does technical complexityimply clinical effectiveness?

patient choice

Which ACS turn up in a DGH?

Which ACS patients should undergo PCI in a DGH?

sick scared peoplewant to be near home