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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