United Kingdom’s Annual Look at PCI Usage Identifies Evolving Patterns

In the last 10 years, the number of patients undergoing percutaneous coronary intervention (PCI) for elective and emergent procedures has increased in the United Kingdom, with the number of primary PCI procedures now more than double what they were just 6 years ago. A full report of the findings, derived from an annual nationwide audit by the British Cardiovascular Intervention Society (BCIS), was published online January 29, 2013, on the Web site of the National Institute for Cardiovascular Outcomes Research (NICOR).

Lead researcher Peter F. Ludman, MD, of Queen Elizabeth Hospital (Birmingham, United Kingdom), collected data on PCI procedures from 97 PCI centers and 7 private hospitals that took place between January and December 2011.

Among the key findings of the BCIS report:

• There has been a yearly increase in the number of PCIs performed in the United Kingdom over the last decade—from 44,913 in 2002 to 88,692 in 2011, or approximately 1,405 cases per million people. This has been achieved by expansion of both the number of PCI centers and activity within existing centers.
• The percentage of patients receiving primary PCI has more than doubled since 2006, amounting to 341 cases per million people in 2011.
• Approximately 80% of all STEMI patients are now treated within 150 minutes, and 92% are treated within 90 minutes of arriving at the PCI center.
• Patients who need to be transferred between hospitals for primary PCI had longer treatment delays than patients admitted directly to a PCI center, with transfers adding about 50 minutes.
• Radial PCI has increased—from 10% in 2004 to over 58% in 2011—and may be responsible for driving down complication rates.
• Evidence suggests that patients treated in PCI centers that perform at least 400 procedures per year have improved outcomes.
• DES have seen an increase in use since 2006, likely due to a better understanding of safety issues.

Better Grasp of Mortality Risk Needed

The report also notes that the overall rate of in-hospital death after PCI has gradually risen from 0.89% in 2007 to 1.6% in 2011. However, the authors attribute this to a change in “case mix,” with an increasing proportion of sicker patients undergoing PCI. This theory is supported by data showing that mortality rates for those undergoing elective procedures, PCI for unstable angina/NSTEMI, and primary PCI have remained stable compared with the previous 8 years, while mortality for rescue PCI has increased (table 1).

Table 1. 2011 In-Hospital Mortality by Procedure Type

According to the authors of the report, the results clearly demonstrate “the importance of risk adjustment in the assessment of outcome to help avoid misleading conclusions.” Since this requires accurate and complete risk-factor data, they say they plan to work with centers to improve the accuracy of hospital-reported data as well as try to validate MACCE reported by the Office of National Statistics through Hospital Episode Statistic data.

“These data provide considerable insight into the practice of PCI, showing not only how practice is evolving over the years, but also how different units compare with each other and how the UK compares with other countries,” Dr. Ludman said in a prepared statement. Importantly, the BCIS report notes, progress is being made; more hospitals are now sending data to NICOR, and there has been a marked improvement in the quality of data submitted.

Ludman PF. British Cardiovascular Intervention Society: National audit of percutaneous coronary interventional procedures public report. Annual public report January 2011-December 2011 [report]. http://www.ucl.ac.uk/nicor/nicor/bcisannualreport2012. Published January 29, 2013. Accessed January 29, 2013.

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