Myocardial Ischaemia National Audit Project - University College ...

Our pPCI service can be illustrated by the case, a 68 yearold man who experienced pain across his chest at 11:45. Hefortunately called for help early at 12:13, and was attended toby the SECAMB within five minutes, see the ECG transmittedto the CCU (Figure 27).He was taken to St George’s Hospital, bypassing his localhospital (8 miles), arriving at the door of the HAC at 13:15 (15miles), and was taken to the CCU first as the pPCI team wasnot on site over the weekend, and then to the cardiac catheterlaboratory when the pPCI team was fully assembled. The callfor help to door time was therefore 62 minutes.He underwent right radial approach emergency coronaryangiography and was found to have occluded his right coronaryartery. The artery re-opened with wiring, without the need forthrombectomy, and it was directly stented at 13:52 (Figure 28,upper panel). Hence the door to balloon time was 35 minutes(well below the golden hour) and the call to balloon time was97 minutes (< 150 minutes).He was also found to have a sub-totally occluded left anteriordescending artery, the distal vessel was collateralised bycollaterals from the re-opened right coronary artery. As therewas high likelihood that he would be symptomatic from thislesion, the artery was wired and directly stented (Figure 28,lower panel). Subsequent echocardiogram revealed preservedcardiac function with mild hypokinesia in the right coronaryartery territory and apical akinesia suggestive of previousdistal left anterior descending artery MI. His recovery wasuneventful. He was discharged 3 days later and was followedup at his local hospital.It has now been one year since the patient’s MI, he hascompleted his cardiac rehabilitation program locally and heis completely asymptomatic. This case illustrates that it ispossible to deliver a world class primary PCI service whendifferent service components work in concert to achieve acommon goal.Figure 27. ECG transferredvia LIFENET system to StGeorge’s Hospital by theambulance crew showingacute ST segment elevationMI in inferoposterior leads.Figure 28. Stages of pPCI toright coronary artery (top),and left anterior descendingartery (bottom). Arrowindicates occluded vessel – leftpanel; star shows inflatedstent balloon – middle panel;and final result of followingstenting – right panel.94 MINAP How the NHS cares for patients with heart attack