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Royal College of Physicians of London.

Clinical Articles, Lead Article

Minap- Primary PCI Overtakes Lytics For The First Time

For the first time, patients in England who have had a heart attack are more likely to have a primary percutaneous intervention (PCI) than receive thrombolysis. Figures from the ninth annual MINAP audit show that 63% of eligible patients had the balloon catheter procedure, compared to 44% in 2008/9. In Wales the increase was from 11% to 22%. Results for local hospitals are contained in the attached report.

The MINAP project is commissioned by the Healthcare Quality Improvement Partnership (HQIP) and run by the National Institute for Clinical Outcomes Research, part of the Institute of Cardiovascular Science at University College London.

minap2Primary angioplasty for eligible patients is the preferred treatment if it can be provided promptly. This year’s results show that 76% of patients that were treated with primary angioplasty were admitted directly to a heart attack centre in England, and 85% in Wales, meaning that the procedure can be carried out more quickly with better patient outcomes.

As more patients are taken directly to hospital for angioplasty, fewer patients were receiving clot-busting drugs, but of those 69% did receive it quickly, within 60 minutes of calling for professional help.  For many ambulance services, the focus has shifted from giving patients lytic drugs in the ambulance before they reach hospital, to making sure patients reach a heart attack centre quickly, so the number of patients receiving treatment in the ambulance has dropped by 36.7%.

These results show a significant sea-change in NHS services, with huge progress towards best practice and better patient outcomes.  Also, fewer patients overall are dying following a heart attack, partly because of the need for hospitals to record and publish their results as part of the MINAP audit.

Professor Roger Boyle, National Director for Heart Disease and Stroke, said:

“This year we have reached a milestone as more than 60 per cent of heart attack patients receive primary angioplasty. This treatment is a clear example of how the NHS can improve outcomes for patients through more efficient services – it is associated with shorter hospital stays and better patient outcomes.”

“Clinical audits like this are vital sources of information for patients and clinicians. We want to expand their use in the NHS so that better information leads to better results for patients and health outcomes that are among the best in the world.”


The ninth annual MINAP Public Report presents analyses from all hospitals and ambulance services in England and Wales that provided care for patients with suspected heart attack from April 2009 to March 2010 (2009/10). It also presents some data from previous years. Its purpose is to inform the public about the quality of local care for heart attack patients.

The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices.  Its aim is to promote quality improvement, particularly the impact clinical audit has on healthcare quality in England and Wales.  HQIP manages and develops the National Clinical Audit and Patient Outcomes Programme (NCAPOP), which currently comprises 30 clinical audits covering an extensive range of medical, surgical and mental health conditions.

Published on: November 3, 2010

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