Percentage of patients discharged on dual anti-platelet therapy (aspirin and either clopidogrel or prasugrel) following percutaneous coronary intervention (PCI)

What is Percutaneous Coronary Intervention (PCI)?

The blood supply to a person’s heart muscle can become impaired by narrowings or blockages that develop in the heart arteries (coronary arteries). When this happens people usually experience sensations that are called ‘angina’. These sensations are quite variable but are often a tightness or crushing feeling across the chest.

For all people with this problem, certain medications are essential in improving symptoms and outcome. In addition, some people gain benefit if the blockages or narrowings can be fixed. Percutaneous Coronary Intervention (PCI) is a technique that is used to mechanically improve blood flow to the heart muscle without resorting to bypass surgery.

PCI usually involves inflation of a balloon within the coronary artery to enlarge the lumen and allow implantation of a stent, which is a metal mesh that holds the walls of the artery open.

Over 96,000 PCI procedures were performed in England in 2014. At UHB, 714 PCI procedures were performed between 1 April 2014 and 31 March 2015.

How is the Trust doing?

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The Trust continues to achieve 100% for this indicator and will monitor this to ensure performance remains high.

Why is this indicator important?

Once a metal mesh has been positioned in the artery, there is a risk that blood will clot on the metal and re-block the artery. This risk is greatly reduced by appropriate treatment with drugs that reduce clotting, specifically drugs that act against platelets (anti-platelet agents). Therefore all patients who have had a stent implanted should ideally take a combination of two anti-platelet drugs. The usual combination is aspirin and clopidogrel but for some patients a combination of aspirin and prasugrel is more appropriate.

Only in exceptionally rare situations such as severe allergic reactions or life-threatening bleeding would the benefits of anti-platelet medication be outweighed by the risks.

How do we measure this indicator?

All patients who have a PCI are checked against the Prescribing Information and Communication System (PICS) to check whether they were discharged on aspirin and either clopidogrel or prasugrel.