This year's results from the Myocardial Ischaemia National Audit Project (MINAP) show that nearly half of heart attack patients are receiving primary angioplasty rather than thrombolytic (clot-busting) drugs. Primary angioplasty is a medical procedure to re-open the blocked coronary artery causing the heart attack, and has better outcomes than thrombolytic drugs.

The MINAP project is commissioned and funded by the Healthcare Quality Improvement Partnership (HQIP) and run by the National Institute for Clinical Outcomes Research at the Heart Hospital, University College London. It collects data from all eligible hospitals and ambulance services in England and Wales - for detailed results by Trusts follow the link below.

In October 2008, the Department of Health announced that primary angioplasty would take over from thrombolytic drugs as England's first line of treatment of heart attacks. The number of hospitals that have performed primary angioplasty increased from 54 to 66 in the last year, although 14 of these hospitals performed less than 10 cases. In Wales two hospitals perform primary angioplasty.

This year's audit results show:

- In England in 2008/9 - 7,351 patients (47% of all receiving treatment) were treated with primary angioplasty compared with 4,035 27% in 2007/8, an increase of 82%
- In Wales in 2008/9 - 118 patients (12%) were treated with primary angioplasty compared to 42 in 2007/8, an increase of 181%
- However, 3/28 English cardiac networks and 1/3 Welsh cardiac networks still have restricted access to primary angioplasty services (less than 10 cases in 2008/9)
- In England 84% of patients were treated within 90 minutes of arrival at the interventional centre compared to 79% in 2007/8
- In England 79% of patients received primary angioplasty within 150 minutes of calling for help
- In Wales 74% of patients were treated within 90 minutes of arrival at the interventional centre compared to 57% in 2007/8
- In Wales 77% of patients received primary angioplasty within 150 minutes of calling for help

There is evidence that from about three hours after the onset of symptoms, primary angioplasty is significantly more effective than thrombolytic treatment in patients with heart attack. At present more than six out of ten patients with heart attack receive one or other form of treatment within three hours of the onset of symptoms. Those who take longer to be treated are mostly those who take a long time to call an ambulance or go to their GP or hospital.

The 2009 report is the eighth report since the project began in 2001, and shows steady improvement year on year:

The speed with which patients receive thrombolytic treatment has been maintained
In 2008/9, 71 % of English hospitals with their associated ambulance services, reached or exceeded the English national target (68%) for the delivery of thrombolysis within 60 minutes of calling for professional help, compared with 71% in 2007/8
82 % of hospitals in England provided thrombolytic treatment to 75% of eligible patients within 30 minutes of arrival at hospital compared to 90% in 2007/8. In Wales the percentage was 50% compared to 42% in 2007/8
The high levels of prescription of secondary prevention medication has been maintained

Recommendations from the report to improve patient care:

Improved access to primary angioplasty services where this is currently unavailable.
For the majority of English hospitals significant reduction in the delay before thrombolytic treatment within hospital is unlikely without compromising safety. There is still room for improvement in Wales.
Efforts should be directed to increase the number of patients in England and Wales who receive pre-hospital thrombolytic treatment, particularly where primary angioplasty is unavailable and long journeys to hospital are involved.

Source
Royal College of Physicians