*******Embargoed until 1 April 2016******
National Audit of Percutaneous Coronary Interventions (NAPCI) – 2014 Annual Public Report
A 48% increase in the use of procedure associated with fewer complications
is good news for cardiac patients
The latest audit from the National Audit of Percutaneous Coronary Intervention (PCI) shows an increase
from 26.9% to 75.3% in the use of a safer method of PCI (angioplasty) between 2007 and 2014.
The PCI procedure, which involves inserting a tube or catheter into the patient’s arterial system to reach
the blocked artery in order to improve blood flow, is associated with fewer complications if carried out
through the radial artery in the wrist rather than the femoral artery at the top of the leg. The significant
increase has been seen in the use of the safer radial access procedure.
Peter Ludman, Consultant Cardiologist and Clinical Audit Lead said:
“The impressive increase in PCI procedures with radial artery access for the treatment of STEMI shows
that UK interventional cardiologists are keeping up to date with developments in their field, and changing
practice in response to evidence showing lower complication rates with this method.
NICE quality standard [QS68] requires that patients presenting with STEMI receive emergency treatment
within 90 minutes from arrival at a specialist heart centre. 90.3% of patients were treated within that time
frame in 2014, and this is similar to the standards achieved in the last 3 years. Reasons for missing the
90 minute treatment target can be the result of admission to a non-specialist heart centre, and transfer
between hospitals.
Ensuring patients are treated by healthcare staff with sufficient expertise is fundamental to providing
excellent care for cardiac patients. The 2005 guidance from the British Cardiovascular Intervention
Society (BCIS) and the British Cardiac Society (BCS) therefore recommends institutions carry out 400 of
these procedures per annum (ppa). However, in the current audit report, 33% of hospitals – both NHS
and private - did not meet this standard.
The audit also reports on patients with unstable angina and non-ST Elevation Myocardial Infarction or
nSTEMI. These patients are at risk of future cardiac events and require urgent but not immediate
treatment. Although NICE quality standard [QS68] sets a target for treatment to be delivered to nSTEMI
patients within 72 hours, over half of all patients are waiting longer than recommended. This is an
avoidable cause of prolonged length of in-hospital stay and increased treatment cost. As with patients
who have STEMI, treatment delays are worse for patients who require transfer to another hospital for PCI
treatment.
Peter Ludman, Consultant Cardiologist and Clinical Audit Lead said:
“As the UK switched from thrombolysis to primary PCI to treat STEMI, the focus was on setting up
emergency care pathways for these patients that is available 24/7. There has therefore been less focus
on patients presenting with UA/NSTEMI. This audit has shown significant delays for these patients, and
we must encourage trusts to set up pathways of care to try to speed up investigation of these patients.
Other messages in the report include:
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Primary PCI is now the default treatment for patients with STEMI representing approximately a
third of all PCI activity in the UK;
Activity levels are now comparable to those in European countries - historically UK levels have
been lower;
Regionally, activity rates range between 300 to 500 procedures per million population, Over the
past three years, patient case mix has stabilised as a result of near national implementation of
primary PCI – the effect of this has been to stabilise overall in-hospital mortality.
Peter Ludman, Consultant Cardiologist and Clinical Audit Lead said:
“The huge effort that goes into collecting these data is a great tribute to all who provide PCI services for
patients in the UK. Analyses of these audit data allow us to understand treatment patterns, the process of
care and outcomes after PCI. Without this information it would not be possible to either be reassured of
satisfactory performance or to be able to highlight areas for potential improvement. We hope patients are
reassured that the profession is carefully measuring the quality of care being provided by operators and
hospitals. The PCI audit will continue to develop ways of disseminating this information so patients,
clinicians, commissioners and other stakeholders can use these data to drive quality improvement
nationally and locally.”
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The full report is available on the BCIS website and a summary will be published on the NICOR
website on 1 April 2016.
Contact details: For further information please contact Lucia Gavalova at l.gavalova@ucl.ac.uk or
on 020 3108 7712.
Notes to Editors:
About National Audit of Percutaneous Coronary Interventions
The National Audit of Percutaneous Coronary Interventional Procedures is clinically led by the
British Cardiovascular Intervention Society and managed by NICOR (National Institute for
Cardiovascular Outcomes Research). It is commissioned by the Healthcare Quality Improvement
Partnership(HQIP) and is run by the National Institute for Cardiovascular Outcomes Research
(NICOR), part of the National Centre for Cardiovascular disease Prevention and Outcomes within
the UCL Institute of Cardiovascular Science. More information can be found at
http://www.ucl.ac.uk/nicor/ and http://www.bsh.org.uk/.
About HQIP and the National Clinical Audit Programme
The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of
Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote
quality improvement, and in particular to increase the impact that clinical audit has on healthcare
quality in England and Wales. HQIP hosts the contract to manage and develop the National
Clinical Audit Programme, comprising more than 30 clinical audits that cover care provided to
people with a wide range of medical, surgical and mental health conditions. The programme is
funded by NHS England, Welsh Government and with some individual audits also funded by the
Health Department of the Scottish Government, DHSSPS Northern Ireland and the Channel
Islands.www.hqip.org.uk
About UCL (University College London)
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first to admit students regardless of race, class, religion or gender and the first to provide systematic
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