Page last updated at 23:14 GMT, Saturday, 18 October 2008 00:14 UK

Q&A: Primary angioplasty

Heart attack
About 60,000 people have a heart attack in England every year

Hundreds of lives could be saved if all eligible heart attack patients in England had access to primary angioplasty, ministers say.

Currently, only a quarter of patients have the operation but the government want it to be available for everyone within three years.

What is primary angioplasty?

It is a procedure to unblock an artery carrying blood to the heart. Under local anaesthetic, a small balloon is inserted with a 2mm-diameter tube via an artery in the groin or arm and guided to the blockage.

Once in place, the balloon is inflated and removed, leaving behind place a rigid "stent" which squashes the fatty blockage in the artery allowing blood to flow through.

For the treatment to work, it has to be done quickly to minimise the amount of damage to the heart muscle from the lack of oxygen that occurs when blood-flow is blocked.

NHS research shows that patients need to have the procedure within two hours of having the heart attack - and the speedier the better.

Who should get it?

There are two basic types of heart attack.

Patients with the most severe kind, known as a ST elevation myocardial infarction or STEMI, have a complete blockage which can be detected by an electrocardiogram.

It is this group - accounting for around 25,000 heart attacks in England every year - who should be treated with primary angioplasty if it can be done quickly enough.

Patients with milder, or non-STEMI, heart attack have partially blocked arteries and can be treated with drugs initially with surgery done if necessary later on.

What other treatment is there?

Use of clot-busting drugs, or thrombolysis, has been the mainstay of heart attack treatment for many years and has led to big reductions in deaths.

These drugs, which are usually given by intravenous drip, activate an enzyme which breaks down blood clots restoring blood-flow.

A national service framework for coronary heart disease launched in 2000 set a target that all eligible patients should receive thrombolysis within an hour of calling the health service.

By 2007/8, about 68% of people treated with thrombolysis received their treatment within 60 minutes.

Patients who have thrombolysis may end up having an angioplasty anyway a few days later.

Why is primary angioplasty better?

Studies have shown that heart attack patients have a 5% or lower risk of death within the next 30 days if they are treated immediately with primary angioplasty.

This is compared with 7% with thrombolysis, which equates to around 240 lives saved in England every year.

But primary angioplasty is also associated with fewer complications and reduced rates of future heart attacks.

It is also estimated that wider use of the procedure could prevent 260 strokes every year.

Patients who have undergone the procedure stay in hospital around three to five days compared with five to nine days after thrombolysis.

Why isn't it widely available already?

Primary angioplasty needs to be done very quickly, which means specialists have to be able to operate at a moment's notice and the patient has to be whisked straight to them by the ambulance.

This does happen in some areas, such as London, where pilot schemes were set up to assess whether the NHS was equipped to carry out this treatment.

Around 25% of eligible patients in England are currently treated with primary angioplasty.

But in order to make this available to all patients, cardiac services will have to be redesigned so large tertiary hospitals have cardiology specialists available 24 hours a day, seven days a week to do the procedure.

Ambulance services also need to be able to diagnose the heart attack and deliver the patients quickly and directly to the specialist teams.

It is hoped within three years, 97% of heart attack patients in the country will be treated this way.


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