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Pulmonary oedemaAn abnormal buildup of fluid in the air sacs of the lungs, whichleads to shortness of breath.QT intervalA measure of the time between the start of the Q wave and theend of the T wave in the heart’s electrical cycle.Re-infarctionThe development of evidence of re-occlusion (furtherblockage) of, or development of blood clot within, the coronaryartery that was responsible for the original heart attack. Thiswould normally occur after the original blockage had beensuccessfully treated.Reperfusion treatmentThe term used to cover both techniques, thrombolytic treatmentand primary PCI, for reopening a coronary artery as anemergency. These treatments are suitable only for certain typesof heart attack characterised by typical electrocardiographicappearances described as ST segment elevation.RevascularisationInterventions that improve the blood supply to the heart,including PCI or coronary artery bypass graftingSecondary prevention treatmentMedication that reduces the risk of further heart attack, or therisk of complications such as heart failure. See aspirin, betablockers, ACE inhibitors and ARBs, clopidogrel and statins.These medications are usually initially prescribed to allpatients who can tolerate them.StatinsDrugs used to reduce cholesterol levels in the blood.ST elevation myocardial infarctionA heart attack characterized by a specific abnormalappearance on the ECG (ST segment elevation) thought to beindicative of complete occlusion of a coronary artery.Thienopyridine inhibitorsAntiplatelet agents, of which clopidogrel and prasugrel arepresently licensed for use. A similar drug, ticagrelor, is alsonow being used in some patients.Thromboembolic complicationsFormation of a clot (thrombus) in a blood vessel that breaksloose and is carried by the blood stream to plug anothervessel. The clot may plug a vessel in the lungs, brain,gastrointestinal tract, kidneys, or leg.Thrombolytic treatmentThe outcome for certain types of heart attack can be improvedby using clot-dissolving (thrombolytic) drugs. Thrombolytictreatment is effective up to about 12 hours after the onset ofsymptoms but is most effective when given very early afterthe symptoms started. Thrombolytic drugs are not givenunless there are typical changes on the electrocardiogram(ECG). As these drugs are designed to dissolve clots, they maybe unsuitable for some patients who are at risk of internalbleeding. Patients at significant risk of bleeding may not begiven this treatment where the risk of bleeding is greater thanany potential benefit. Where this risk exists primary PCI maybe an effective alternative.ThrombusA blood clot, the development of which is known a thrombosis.VentriculographyA medical imaging test used to determine a patient’s cardiacfunction which involves an injection of a dye that shows up onX-rays, into the heart’s ventricles to measure the volume ofblood pumped.Appendix 4: MINAP Publications1999Rickards A, Cunningham D. From quantity to quality: the centralcardiac audit database project. Heart 1999;82: 1118-1122Birkhead JS, Norris RM, Quinn T et al. Acute myocardialinfarction: a core dataset. Royal College of Physicians 1999.2000Birkhead JS. Responding to the requirements of the NationalService Framework for coronary heart disease: a core dataset formyocardial infarction. Heart 2000; 84: 116-72001Birkhead JS, Pearson M, Norris RM et al. Measurement ofClinical Performance: Practical approaches in acute myocardialinfarction. Eds Robert West and Robin Norris. Royal College ofPhysicians 2001.Birkhead JS, Georgiou A, Knight L et al. (eds) A baselinesurvey of facilities for the management of acute myocardialinfarction in England 2000. London: Royal College ofPhysicians 20012002Birkhead JS. The National Audit of Myocardial Infarction: A newdevelopment in the audit process. Journal of Clinical Excellence2002; 4: 379-85.2004Norris RM, Lowe D, Birkhead JS. Can successful treatmentof cardiac arrest be a performance indicator for hospitals?Resuscitation. 2004; 60: 263-269.104 MINAP How the NHS cares for patients with heart attack
Birkhead J, Walker L. MINAP, a project in evolution. Hospitalmedicine 2004; 452-53.Birkhead J, Walker L, Pearson M, at al. Improving care forpatients with acute coronary syndromes; initial results fromthe National Audit of Myocardial Infarction (MINAP). Heart2004; 90: 1004-9.2005Quinn T, Weston C, Birkhead J, et al on behalf of SteeringGroup. Redefining the coronary care unit: an observational studyof patients admitted to hospital in England and Wales in 2003-2005. Quarterly Journal of Medicine 2005; 98 (11): 797-802.2006Birkhead, J, Weston, C, Lowe, D on behalf of the NationalAudit of Myocardial Infarction project (MINAP) SteeringGroup. Impact of specialty of admitting physician and type ofhospital on care and outcome for myocardial infarction in Englandand Wales during 2004-5: observational study. BMJ 2006;332:1306-1311.Gale CP, Roberts AP, Batin PD, Hall AS. Funnel plots,performance variation and the Myocardial Infarction NationalAudit Project 2003-2004. BMC Cardiovasc Disord. 2006 Aug2;6:34.2007Weston C, Walker L, and Birkhead J. Early impact of insulintreatment on mortality for hyperglycaemic patients withoutknown diabetes who present with an acute coronary syndrome.Heart 2007; 93: 542-1546.Birkhead J, Pearson J, Walker L on behalf of the MINAPSteering Group. Management of acute coronary syndromes inEngland and Wales: a survey of facilities in 2006. Royal College ofPhysicians, London 2007. ISBN 978-1-86016-314-2.2008Weston C. Performance indicators in acute myocardial infarction:a proposal for future assessment of good quality care. Heart2008; 94:139-1401.Gale CP, Manda SO, Batin PD, et al. Predictors of inhospitalmortality for patients admitted with ST-elevationmyocardial infarction: a real-world study using the MyocardialInfarction National Audit Project (MINAP) database. 2008Nov;94(11):1407-12.Ben-Shlomo Y, Naqvi H, Baker I. Ethnic differences inhealthcare-seeking behaviour and management for acutechest pain: secondary analysis of the MINAP dataset 2002–2003. Heart 2008; 94: 354 - 3592009Gale CP, Manda SO, Weston CF, et al. Evaluation of riskscores for risk stratification of acute coronary syndromes in theMyocardial Infarction National Audit Project (MINAP) database.2009 Mar;95(3):221-7.Bhaskaran K, Hajat S, Haines A, et al. Effects of air pollution onthe incidence of myocardial infarction. Heart,2009; 95, 1746-59.Horne S, Weston C, Quinn T, et al. The impact of pre-hospitalthrombolytic treatment on re-infarction rates: analysis of theMyocardial Infarction National Audit Project (MINAP). Heart 2009;95: 559-563.Birkhead J, Weston C, Chen R. Determinants and outcomes ofcoronary angiography after non-ST-segment elevation myocardialinfarction. A cohort study of the Myocardial Ischaemia NationalAudit Project (MINAP). Heart 2009; 95:1593-9.Bhaskaran K, Hajat S, Haines AP, et al. Effects of ambienttemperature on the incidence of myocardial infarction. Heart2009, 95, 1760-9.2010Herrett E, Smeeth L, Walker L, Weston C; on behalf of theMINAP Academic Group. The Myocardial Ischaemia NationalAudit Project (MINAP). Heart 2010;96:1264-1267.Bhaskaran K, Hajat S, Haines AP, et al. The short termeffects of temperature on the risk of myocardial infarction inEngland and Wales – a multicity daily time series study using theMyocardial Ischaemia National Audit Project (MINAP) database.BMJ 2010;341: c3823.West RM, Cattle BA, Bouyssie M et al. Impact of hospitalproportion and volume on primary PCI performance in Englandand Wales. European Heart Journal 2010.; 32(6):706-11McNamara RL. Cardiovascular registry research comes of age.Heart 2010; 96:908-10.Brophy S, Cooksey R, Gravenor MB, et al. Population basedabsolute and relative survival to 1 year of people with diabetesfollowing a myocardial infarction: a cohort study using hospitaladmissions data. BMC Public Health 2010;10:338.Widimsky P, Wijns W, Fajadet J, et al. European Associationfor Percutaneous Cardiovascular Interventions. Reperfusiontherapy for ST elevation acute myocardial infarction in Europe:description of the current situation in 30 countries. Eur Heart J2010; 31:943-572011Gale CP, Cattle BA, Woolsten A, et al. Resolving inequalitiesin care? Reduced mortality in the elderly after acute coronarysyndromes: Myocardial Ischaemia National Audit Project 2004-2010. Eur Heart J. 2012 Mar;33(5):630-9. Epub 2011 Oct 18.MINAP Eleventh Public Report 2012 105
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Myocardial IschaemiaNational Audit
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Myocardial Ischaemia National Audit
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ForewordThe annual MINAP Report, no
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Patients who received thrombolytic
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considering such factors as the age
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egarding previous medical history.
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3. Improving quality,improving outc
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is an acute heart failure syndrome
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Alan KeysMINAP Steering Group patie
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Figure 7. Patients admitted with a
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Figure 11. Percentage of patients w
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transfers require a significant amo
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Table 8 shows the performance of th
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This year we report on the interval
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Conquest Hospital, St Leonards onSe
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Royal Derby Hospital, Derby 62 89%
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“During times of financial constr
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Broomfield Hospital, Chelmsford 0 0
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Leighton Hospital, Crewe 43 86% 49
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Royal Preston Hospital, Preston 48
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Wycombe Hospital, High Wycombe 11 1
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“I know that MINAP data has been
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Cheltenham General Hospital, Chelte
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Manchester Royal Infirmary, Manches
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Salford Royal Hospital, Manchester
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“MINAP, and its long history, is
Page 53 and 54: Table 6: Ambulance Services in Engl
Page 55 and 56: Bradford Royal Infirmary, Bradford
Page 57 and 58: Hexham General Hospital, Hexham 17
Page 59 and 60: Papworth Hospital, Cambridge 560 99
Page 61 and 62: Salisbury District Hospital, Salisb
Page 63 and 64: West Middlesex University Hospital,
Page 65 and 66: “We have participated in MINAP fr
Page 67 and 68: Dorset Cardiac and Stroke Network 7
Page 69 and 70: “Participation in MINAP has helpe
Page 71 and 72: Blackpool Victoria Hospital, Blackp
Page 73 and 74: Harefield Hospital 139 84% 156 94%
Page 75 and 76: Northern General Hospital, Sheffiel
Page 77 and 78: Royal Victoria Infirmary, Newcastle
Page 79 and 80: Warrington Hospital, Warrington 435
Page 81 and 82: Withybush General Hospital, Haverfo
Page 83 and 84: Part Three: Case Studies1. Call act
Page 85 and 86: 3. Implementing a high-risk nSTEACS
Page 87 and 88: The British Heart Foundation is a r
Page 89 and 90: of six individual criteria - all in
Page 91 and 92: 9. Use of MINAP data to develop and
Page 93 and 94: Figure 26. Part 2 collected by Card
Page 95 and 96: 12. Shifting the FocusNicola Mannin
Page 97 and 98: Figure 29. Funnel plot of hospital
Page 99 and 100: Figure 30. Estimated excess risk of
Page 101 and 102: Part 6: AppendicesAppendix 1: MINAP
Page 103: Coronary thrombosisThe formation of
Page 107: Heart attacks recorded in MINAP in
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