PenCHORD - STEMI: Appropriate treatment for ST-elevation heart attacks
The standard care for acute ST-elevation myocardial infarction (STEMI) is Primary Percutaneous Coronary Intervention (PPCI), otherwise known as coronary angioplasty. Administering PPCI treatment requires a patient to be transferred to a centre specialising in the technique.
STEMI heart attacks were previously treated with thrombolysis (clot-busting drugs) administered by paramedics before patients were taken to hospital. With the national roll-out of emergency angioplasty (PPCI) this was replaced by transfer to a centralised PPCI centre.
However, data analysis suggests that in rural areas, overall mortality has not been improved by this change in treatment and people living furthest away from the PPCI centres may potentially be disadvantaged.
Although there is substantial evidence suggesting that, all other things being equal, PPCI is a superior treatment to thrombolysis, it may be that the delay in transfer to hospital in rural areas, and any subsequent in-hospital delay for PPCI, cancels out the potential benefit of PPCI.
Working with Taunton and Somerset NHS Foundation Trust, PenCHORD is modelling the ‘winners and losers’ in the transition from pre-hospital thrombolysis to centralised PPCI, and will investigate the potential benefit of a mixed-model approach combining emergency thrombolysis (for those furthest from a PPCI centre) with centralised PPCI.
The project aims to analyse whether receiving thrombolysis treatment from paramedics before being taken to hospital could lead to better outcomes for some STEMI patients, by reducing delays caused by the travel time needed to move them to a PPCI hospital for treatment.
The project team will sample STEMI patients whose nearest PPCI hospital is Musgrove Park Hospital in Taunton to compare the results of three different treatment pathways:
- Pre-hospital thrombolysis for all STEMI patients
- Using PPCI for all patients for all STEMI patients
- A mixed model of PPCI and thrombolysis which depends on the location of each patient
The model will compare the time between paramedics arriving on-scene and administering pre-hospital thrombolysis, versus the time between the paramedics arriving and the patient arriving at hospital and receiving PPCI.
It will consider factors that may influence which treatment pathway is the most suitable for different patients, including:
- The location of the patient
- The severity of the myocardial infarction (heart attack)
- The time of day or week.