NICE Guidance Recommends PPCI over Clot-Busting Drugs
The UK's National Institute for Health and Care Excellence (NICE) has issued a revised guideline recommending use of coronary angioplasty, thrombus extraction catheters and stenting - collectively known as primary percutaneous coronary intervention (PPCI) - for a heart attack known as ST-segment-elevation myocardial infarction (STEMI), rather than clot-busting drugs (fibrinolysis) in the first 2 hours after the onset of STEMI.
The guidance offers the following key recommendations for clinicians:
- Offer coronary angiography, with follow-on primary PCI if indicated, as the preferred coronary reperfusion strategy for people with acute STEMI if presentation is within 12 hours of onset of symptoms and Primary PCI can be delivered within 120 minutes of the time when fibrinolysis could have been given.
- Do not use level of consciousness after cardiac arrest caused by suspected acute STEMI to determine whether a person is eligible for coronary angiography (with follow-on PPCI if indicated).
- Offer fibrinolysis to people with acute STEMI presenting within 12 hours of onset of symptoms if primary PCI cannot be delivered within 120 minutes of the time when fibrinolysis could have been given.
- When commissioning PPCI services for people with acute STEMI, be aware that outcomes are strongly related to how quickly PPCI is delivered, and can be influenced by the number of procedures carried out by the PPCI center.
The number of people who die in hospital after a heart attack has fallen in the UK from around 20% in the early 1980s to roughly 5% now. This has been attributed to various factors, including improved drug therapy and speed of access to effective treatments. Although the number of people suffering these severe heart attacks has been falling over the past 20 years, they still account for around 35,000 hospital admissions in England and Wales each year.