Sault Area Hospital gets green light for PCIs

Timely access for life-saving procedure will save lives

Lisa Barnett, cardiac care co-ordinator with Lil Silvano, director of clinical programs, and Dr. Rishi Ghosh, medical director of critical care and cardiology in Sault Area Hospital’s current catheterization lab.

Beginning in April 2018, heart attack patients in Algoma requiring percutaneous coronary intervention will be able to have the procedure performed close to home, following Ministry of Health and Long-Term Care approval in July for an expanded cardiology program at Sault Area Hospital (SAH).

Until now, patients requiring the procedure had to be transported by air ambulance to Health Sciences North in Sudbury or St. Michael’s Hospital in Toronto in emergency situations, or find their own way to one of Ontario’s 18 advanced cardiac care hospitals for a scheduled, non-emergency angioplasty.

According to Lil Silvano, director of clinical programs at SAH, an average of 320 Algoma patients risk the trek to Sudbury or Toronto every year for the life-saving procedure.

“The major risk is timely access to reperfusion for cardiac disease,” said Dr. Rishi Ghosh, medical director of cardiology and critical care.

“It’s well accepted that the longer we wait getting blood flow back to a heart that’s been compromised in terms of vascular supply, the worse the cardiac status in terms of muscle death, poor cardiac condition and poor recovery.”

Having timely access for a life-saving procedure that can be delivered close to home will save lives, said Ghosh, citing the loss of several patients over the years who died waiting for a transfer or while en route to another hospital.

“We offer thrombolytic treatment to patients having an acute cardiac infarction to open a clot or blocked vessel and buy some time so they can be transported to a receiving centre for PCI, but there are many cases where thrombolytics don’t work,” said Ghosh. “In these cases, patients complete their cardiac infarction and have complications stemming from arrhythmias, all the way to congestive heart failure and death.

“Thrombolytics open up a little bit of the blockage and restore a little perfusion, but it falls short of the standard of care which is the deployment of a stent to fully open up a blocked artery.”

Seeking approval for an expanded cardiology program has been a topic of conversation for years but a formal request was only made in June 2014.

To get up and running, SAH will be working closely with the cardiology group at St. Michael’s.

“Their cardiologists will be coming to Sault Area Hospital on a rotating basis a few days a week to help perform angiographies, but ultimately with the goal of mentoring us as a PCI site,” said Ghosh. “St. Mike’s has a lot of highly skilled, world- renowned physicians who can help guide us to develop what we hope will be a premier PCI service for Northern Ontario. We’re also working with them for permanent recruitment to help attract new grads or experienced physicians to come to Sault Ste. Marie on a full-time basis.”

The Sault hospital currently has one catheterization lab and performs 800 to 850 angiograms a year, but recently lost one of its cardiologists. Now it is reliant on doctors from St. Mike’s to help with its current volume of angiograms, said Silvano.

The ministry has approved funding for construction of a second cath lab, but the hospital will have to raise approximately $4 million from the community to cover the cost of the necessary equipment.

“The ultimate goal is to provide a primary PCI service, which means we would be operating 24/7 and if someone comes in with an emergency, we can offer door to balloon time of 90 minutes,” said Silvano.

However, in the short term, “we will begin performing less complex cases until we build up our expertise and experience,” she added.

Having the capability of performing PCIs locally will dramatically reduce transfers to Sudbury and Toronto, but SAH will not be able to perform 100 per cent of the angioplasties required in Algoma, cautioned Lisa Barnett, cardiac care co-ordinator, because it will be a standalone PCI site without cardiac backup for more complex cases.

The hospital has set its sights on recruiting between three and five interventional cardiologists for the expanded program.

Health Sciences North and Thunder Bay Regional Health Sciences Centre are currently the only hospitals in Northern Ontario performing PCIs.

PCI by the numbers 2015/16

Volumes
25,498
PCIs performed in Ontario

1,500
PCIs performed at Health Sciences North

750
PCIs performed at Thunder Bay Regional

Wait times
45 minutes (median)
door-to-balloon time, ambulance transfers to HSN

125 minutes (90th percentile)
door-to-balloon time, ambulance transfers to HSN

80 minutes (median)
door-to-balloon time, ambulance transfers to Thunder Bay Regional

128 minutes (90th percentile)
door-to-balloon time, ambulance transfers to Thunder Bay Regional

380 minutes (median)
door-to-balloon time, transfers to HSN from non-PCI centres

1,380 minutes (90th percentile)
door-to-balloon time, transfers to HSN from non-PCI centres

Source: Cardiac Care Network Annual Report, 2015/16. For more stats on PCI volumes and wait times, go to www.ccn.on.ca

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