There have been major changes in the delivery of services to patients with coronary disease over the last two decades. These include primary percutaneous coronary intervention (PCI) for patients with ST elevation myocardial infarction (STEMI) and an early invasive strategy for those with non-STEMI acute coronary syndromes (ACS). In these settings patients undergo angiography with a view to immediate angioplasty (so-called “follow-on” or “ad-hoc” angioplasty) or early coronary artery bypass grafting (CABG). Chest pain clinics identify patients who need early angiography and these and other elective patients are frequently listed for a potential follow-on procedure. These changes have made revascularisation units more efficient, with greater patient throughput and reduced hospital bed-days. In the UK, they have played a major part in significantly reducing waiting times for procedures.
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