Setting up a primary percutaneous coronary intervention service

Primary percutaneous coronary intervention (PPCI) has been shown to be the most effective treatment in restoring the coronary blood flow of patients with an ST-segment elevation myocardial infarction (STEMI). PPCI has also been shown to have better long-term survival rates, result in fewer non-fatal re-infarctions and cause fewer haemorrhagic strokes compared to patients treated with thrombolysis. It is only in the last 3 years that the government has decided to pilot the feasibility and cost-effectiveness of developing a nationwide PPCI service. This paper describes how a tertiary centre for cardiac services set up a 24-hour PPCI service and some of the problems that occurred. It also discusses the protocols and guidelines that were developed and issues around bed management and staffing levels. This paper also considers the educational needs of the staff, cost implications of this service and the impact this service had on the cardiac rehabilitation department.