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Primary angioplasty on the increase

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The number of patients in England receiving primary angioplasty instead of thrombolysis following myocardial infarction has increased significantly over the last year, latest findings show.

However, the service remains a lottery in some parts of the country, including Wales, according to the Myocardial Ischaemia National Audit Project (MINAP) report, published last week by the Royal College of Physicians.

A total of 4,472 patients were treated with primary angioplasty in England in 2007–2008, an increase of 42% from the previous year’s total of 3,148. The number of cases in Wales has also increased, by 20%, but only from 44 patients in 2006–2007 to 53 in 2007–2008.

Overall, 54 hospitals in England now carry out the procedure, which uses a balloon to reopen the blocked coronary artery and a stent to keep blood flowing. But seven out of 30 English cardiac networks have ‘very restricted access’ to primary angioplasty services, treating less than 10 cases in 2007–2008, and only two hospitals in Wales carry out the procedure.

Professor Roger Boyle, the government’s national clinical director for heart disease and stroke, set out the clinical case for moving from thrombolysis to primary angioplasty in December 2006.

‘Primary angioplasty is very successful and is considered to be the treatment of choice where possible,’ said Glain Jones, head of nursing for the cardiac division at King’s College Hospital in London.

‘But not all hospitals will have the facilities or staff to be able to offer this service,’ she added. Ms Jones suggested patients who lived in more rural areas could still be treated with pre-hospital thrombolysis.

June Davison, cardiac nurse at the British Heart Foundation, said inequalities in treatment need to be addressed.

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