The introduction of Primary Percutaneous Coronary Intervention (PPCI) for the treatment of acute ST elevation myocardial infarction (STEMI) represents one of the success stories of modern cardiovascular care. However, unlike a new medication, it requires system-wide change. In their paper, Hall et al1 describe the process of implementation of PPCI in the UK between 2003 and 2013, the period of most rapid switch in practice from thrombolysis to PPCI.

The Myocardial Infarction National Audit Project (MINAP) database was established in 1998 to monitor the implementation of thrombolysis in England and Wales. By mid-2002, all acute hospitals in England and Wales were participating, thus providing near complete coverage and data accuracy for patients with STEMI. MINAP provided a unique window on the roll-out of PPCI.

The key findings are that proportions of STEMI treated by PPCI increased over a period of 10 years from 0.01% to 86.3%, but …