1. Heart of the Matter 23 rd November 2010 Steve Leslie Interventional Cardiologist Highland What, Why and Where? Coronary Angioplasty in NHS Highland

2. Burden of coronary disease Eur Heart J 2008 29:1316-1326 Coronary Heart Disease Statistics (2003)

8. Standard PCI kit Guiding catheters Guidewires Angioplasty balloon Deployed stent

9. New developments

10. Evolution of Angioplasty High success Low morbidity Dr. Don Baim, FDA Panel Meeting December 2006 0 10 20 30 40 POBA early POBA late Stent early Stent late DES Event Rate % 1977 1985 1997 1994 2003-present Failure Em CABG Restenosis Stent thrombosis VLST Innovations over time

12. Cardiac Catheterisation Laboratory (the ‘cath lab’)

14. Coronary angioplasty

16. Risk of Stent thrombosis

18. Fox et al . Lancet 2002; 360 :743-751 Non STEMI (n~600)

23. Primary PCI 33 38% 3% 5% 8% Long term mortality (6-18months) 33 36% 3% 5% 8% Short term mortality (4-6weeks) PCI Thrombolysis NNT Relative RR Absolute RR Event Rate Clinical indices Advantages of primary percutaneous coronary intervention over thrombolysis. 81 When this cannot be achieved within 90 minutes of diagnosis patients should receive immediate thrombolytic therapy D Patients with an ST elevation acute coronary syndrome should be treated immediately with PPCI A Those presenting < 6hours who fail to reperfuse should be considered for rescue PCI B

24. Heart Attack Centres population 340,000 Elderly migrant population Holiday influx

25. Drive times

29. Not just about plumbing!

30. Thank you