Bradford Acute Coronary Syndrome study – the impact of primary percutaneous coronary intervention in a tertiary centre: a review of the process

Introduction

The Bradford Acute Coronary Syndrome (BACS) study was set up after the introduction of 24-hour primary percutaneous coronary intervention (pPCI) service in a tertiary centre, the Leeds General Infirmary (LGI), approximately 15 miles away from the initial site of presentation. This paper reviews the process, the demographics and the challenges faced with the introduction of pPCI in a tertiary centre remote from our hospital, the Bradford Royal Infirmary (BRI). The BRI is an urban hospital serving a population of about half a million people, and our busy emergency department (ED) sees in excess of 110,000 new patients per year.

Methods

Data from all acute coronary syndromes presenting to the ED at the BRI are stored prospectively on a database. The BACS study reviewed patients presenting between 22 May 2005 and 21 May 2007, 1 year before and 1 year after the introduction of 24-hour pPCI, which commenced on 22 May 2006. A structured analysis of the database was performed for the purpose of this paper. Data concerning treatment modalities, times to achieve treatments and all the complications were tabulated and presented graphically.

Results

The study looked at 161 patients who had presented in the year prior to the introduction of pPCI, and 156 patients who had attended the ED at the BRI in the year after pPCI was introduced. After the introduction of 24-hour pPCI, 87 (56%) patients had primary angioplasty at the LGI, 24 (15%) had angiogram only at the LGI, two (1.3%) had primary angioplasty at the BRI, eight (5%) were thrombolysed at the BRI, three (2%) were thrombolysed at the LGI, one (0.7%) was thrombolysed prehospitally, 26 (17%) had medical management at the BRI and five (3%) patients had medical management at the LGI. Of 119 patients transferred to the LGI, 87 (73%) had primary angioplasty, 24 (20%) had only angiogram, three (2.5%) were thrombolysed, and five (4.5%) were managed medically.

Conclusion

pPCI is the gold standard for the management of acute myocardial infarction. This paper by the BACS study group reviews the processes, the demographics of patients, and the complications that can occur in patients who present with acute myocardial infarctions and need to be transferred to a tertiary centre where onsite 24-hour pPCI service is available.