Primary PCI: Call-to-balloon time within 120 minutes
What this data shows:
For those patients whose heart attacks are characterised by elevation of the ST segment on ECG, rapid restoration of coronary artery blood flow by percutaneous coronary intervention (PCI) reduces the extent of heart muscle damage, and so limits the size of the heart attack. The sooner PCI can be provided following the onset of symptoms of heart attack the greater is the potential benefit.
How the data is gathered:
Achieving a short call to balloon time requires swift and coordinated action between the emergency ambulance services and admitting hospitals to reliably and safely identify patients who will benefit from PCI and then to provide it. The call to balloon time is therefore a measure of performance of a system of care and not just of the hospital where the PCI takes place. It is the interval between the first call for professional help and the time that the PCI procedure is performed.
The indicator reflects the proportion of patients who undergo primary (emergency) PCI within (and up to) 120 minutes of the call for professional help within each interventional hospital.
Not every hospital has the capacity to provide emergency (primary) PCI. Those that cannot are often termed ‘non-interventional’ hospitals, and will not be assigned a value for the call to balloon time indicator. Those hospitals that can provide PCI are often referred to as ‘Interventional centres’. A call to balloon time indicator is assigned only to interventional hospitals that performed at least 20 procedures during the year.
Ambulance services will usually transport a patient with probable STEMI directly to an interventional hospital. Sometimes patients are assessed at a non-interventional hospital prior to onward travel to an interventional hospital. Such patients are included in this indicator – and assigned to the receiving interventional hospital.
Patients who ‘self-present’ to hospital – i.e. those who do not call the emergency services to attend them, but rather make their own way to hospital – are included in the analysis of data.
When the data is shown:
The call-to-balloon time is a measure of performance of a system of care and not just of the hospital where the PCI takes place.
Those hospitals with a higher value for this indicator are those within which a higher proportion of patients receive PCI within 2 hours of calling for help.
In some rural areas travelling times to hospital will result in prolonged call-to-balloon times that cannot be much improved by admitting hospitals.
More information about the data source:
The data is collected as part of the national audit of heart attack management (MINAP) commissioned by the Healthcare Quality Improvement Partnership. Individual participating hospitals collect data on the management of patients and upload information (using encryption) to NICOR, for data-cleaning, storage and analysis. Hospitals also participate in an annual data validation exercise.
Data Source:
National Cardiac Audit Programme (NCAP) Annual Report 2018 (Due to be published 14th June 2018)
Data Period:
April 2016 – March 2017
Data Supplier:
Myocardial Ischaemia National Audit Project (MINAP) via the National Institute for Cardiovascular Outcomes Research (NICOR) at Bartshealth NHS Trust