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PPPCI ONE YEAR ON JCUH AUDIT DATA

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PPPCI ONE YEAR ON JCUH AUDIT DATA

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    1. PPPCI ONE YEAR ON JCUH AUDIT DATA Jim Hall Jackie Tough The James Cook University Hospital Middlesbrough

    2. PPCI pathway Activations with no PPCI OOANMI LBBB Outcome data Process monitoring data

    5. PPCI ROLL-OUT PHASE 1- MIDDLESBROUGH 2004 PHASE 2 – N YORKS 2006 PHASE 3 – TEESSIDE 2008 JAN PHASE 4 – COUNTY DURHAM 2008 MAY PHASE 5 – CUMBRIA ?

    10. STEMI activations with no PPCI No angiogram 8% Late presentation AF rate related ST elevation LVH only Acute LVF + ineligible ECG Very old changes ST elevation resolved Died before angio (4 patients) Pt refused (1 patient)

    16. LBBB and STEMI LBBB MINAP 2004/5 25,748 STEMI 5% LBBB (50% inappropriate lysis?)

    17. LBBB and STEMI PAMI trials 3053 STEMI pts 1.6% LBBB Higher mortality 14.6% cf 2.8% older, lower EF, DM, multVD etc

    18. LBBB and STEMI NRMI-2 registry LBBB 3% of MI age <65 10% of MI age >75 ~ 20% get reperfusion therapy

    22. LBBB triaged to UHH+UHND 01/01/09-31/03/09

    29. PERFORMANCE MEASURES AND PPCI C2B a measure of the process from ‘call for help’ D2B a measure of the process at the heart attack centre

    30. PERFORMANCE MEASURES AND PPCI Monitoring target C2B median <120 mins or 75%<150mins D2B median <60 mins or 75% <90 mins inclusive of all-comers!

    41. PPCI ONE YEAR ON - JCUH DATA Conclusions: Increased activity ~ 55/month 25% of activations not PPCI OOANMI huge growth mortality has fallen improved D2B and C2B long travellers C2B compensated for by shorter D2B continuous review improves processes

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