The pace of interventional cardiology is accelerating across Europe, although there is wide variation in provision.1 The enthusiasm for immediate or very early intervention in patients with acute ischaemic coronary syndromes places huge demands on health care services, demands that are likely to increase as the “urgency to intervene (in order to reperfuse)” philosophy spreads. What could be the implications for such a policy for the UK National Health Service?

Each year approximately 300 000 patients suffer an acute myocardial infarction in the UK, of whom approximately 200 000 reach hospital alive. The 28 day case fatality rate for these patients remains unacceptably high at between 20% and 25%.2 ,3 Over the past 25 years, registry data have shown a relatively stable admission rate for patients with acute myocardial infarction, but an enormous increase in patients with non-infarct ischaemic pain, a ratio of at least 5:1.4 …