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69 Referral to angiography for non-st-elevation acute coronary syndrome patients: are we following the local guidelines?
  1. Ahmed Elamin1,
  2. Marwa Daghem2,
  3. Clare Appleby2
  1. 1Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, MSY L14 3PE, United Kingdom
  2. 2Liverpool Heart and Chest Hospital


Background National Institute of Clinical Excellence (NICE) guidance suggests that patients with non-ST elevation myocardial infarction (NSTEMI) should undergo invasive angiography within 72 hrs of admission. Delivery of timely angiography is challenging; the aim of this study was to assess compliance and identify gaps at a regional level.

Methods We performed a retrospective analysis of all patients transferred to Liverpool Heart and Chest Hospital (LHCH) for invasive management of NSTEMI between March 2019 to February 2020. We identified multiple time points along the ACS patient pathway including: time taken from local hospital admission to referral to LHCH; time taken for referral acceptance; and time taken from LHCH acceptance to admission to LHCH.

Results 1723 patients (mean age 66±12 years; 37.2% female) with NSTEMI were included in the analysis-Table 1. From first hospital admission to transfer to tertiary centre catheter laboratory for angiography, the target of 72 hrs was achieved in only 21% of patients. Median time from admission to district general to admission to tertiary centre was 110.00 hr (4 days and 14 hrs). 40% of patients were referred within 24 hrs of admission and 74% in less than 48 hr. 74% of patients were accepted within 24 hrs of referral. The median acceptance to admission time was 49 hr. 91% of patients were taken into catheter lab within 24 hours of admission to tertiary centre – Figure 1.

Conclusion In patients with NSTEMI timing of invasive treatment is not delivered according to national recommendations. There appear to be delays at each stage of the ACS pathway. Multiple factors may contribute to this delay including transportation delays, in addition to beds and catheter laboratory capacity in the tertiary centre. More research is needed to look into each stage independently, in order to be able to achieve the targets set by NICE.

Abstract 69 Table 1

Patient demographics

Abstract 69 Figure 1

Summary of the median/mean percentages of acute coronary syndrome with non-ST elevation MI cohort we achieved within 72 hours window periods

Conflict of Interest None

  • ACS
  • Timing of Angiography
  • NICE

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