DR SCOTT'S SURGERY; In association with the NHS North East.

Byline: DR SCOTT

WHEN I qualified as a GP there was a lot of controversy about how and where to manage people who were having heart attacks.

A number of papers were written which suggested with close supervision many people were more safely treated at home.

Heart attacks are more precisely described as Myocardial Infarction (MI). This term describes the death of some of the heart muscle due to the cutting off its blood supply.

It would be almost impossible to find anyone who agreed with treating them at home nowadays.

Paramedics, a rare commodity in the 1970s, are now recognised as having essential skills which make the transfer to hospital much safer.

Hospital treatment itself has become much more effective. Thrombolysis, in which drugs are used to dissolve the clot which is blocking the coronary artery, has increased survival rates.

This has transformed the treatment of MI, but we are now starting on another revolution in treatment - PPCI.

Percutaneous Coronary Intervention has been used increasingly over the last few years. A fine tube, the catheter, is threaded through the skin into an artery, usually in the groin or arm, which is threaded into the artery within the heart, one of the coronary arteries, which is blocked.

A stent is positioned under X-ray control to open the artery and then hold it open in a dilated position, allowing blood to flow again.

Imagine you had a tough, deflated balloon wrapped in chicken wire. You could place this in a collapsed pipe.

Blowing up the balloon on the end of a long tube would open up the pipe and the expanded chicken wire would continue to hold the pipe open after you pulled the tube and deflated balloon out.

Cardiologists, working in the catheter lab, do much the same thing with patients' hearts. The stent is the chicken wire. This procedure has been performed thousands of times in the UK, but mostly for patients who presented with special problems or did not respond to simple thrombolysis.

In fact, almost everyone who is having an MI severe enough to cause specific changes on the cardiograph, called ST elevation (STEMIs), will benefit from this.

In order to save lives and reduce disability, this should be the first line treatment for everyone with an ST-elevated MI.

Called Primary PCI this is the treatment I would want to have. To provide this care is a massive task. Ideally it should be performed within 90 minutes of the start of the chest pain, whatever time of the day or night this is.

Not all hospitals have catheter labs where this procedure can be done. Newcastle's Freeman Hospital has built new facilities so patients can be transferred on to the operating table to within seconds of the ambulance arriving.