Only 37% of patients with a major heart attack, known as an ST elevation myocardial infarction (STEMI). sought medical help within 60 minutes of onset of their symptoms, according to the Irish Heart Attack Audit National Report 2017-2020, which was launched at the National Office of Clinical Audit (NOCA) Annual Conference 2022, in association with RCSI Charter Week.
The gold standard treatment for these patients is primary percutaneous coronary intervention (primary PCI). This involves inserting a wire into the blocked artery in order to open it with a balloon and stent and should be performed in a timely fashion, defined internationally as equal to or less than 120 minutes from first medical contact. Since 2012, a standardised national STEMI care pathway has delivered primary PCI at 10 PCI locations in Ireland aiming to improve access to and the timeliness of primary PCI.STEMI
The audit showed that 68% of STEMI patients were admitted to a PCI directly, with 28% still presenting to a non-PCI hospital first. This can lead to delays in reperfusion which directly affects heart attack survival – in this analysis, patients who had a timely primary PCI had a 2.8% in-hospital mortality rate, compared to 5.2% in patients who were treated beyond the 120 minute window.
Prof. Ken McDonald National Clinical Lead, National Heart Programme said “It is clear that improved public health messaging encouraging patients to call 112 or 999 for help when they experience signs of a heart attack is necessary, given that only 37% of patients with a STEMI called for help within 1 hour of symptom onset over the 4-year reporting period.
Dr Ronan Margey Clinical Lead of the Irish Heart Attack Audit (IHAA), said, “This report highlights the considerable progress that has occurred since 2012 in broadening access to primary PCI as the preferred treatment for STEMI heart attack. It shows the current quality of care delivered by our ambulance service personnel, emergency doctors and nurses, cardiologists, and cardiac nurses throughout our hospital system, but particularly in the PCI centres.”
This report analysed data on 5,629 patients with a STEMI over a four-year period, 2017-2020.
