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Day-case transfer for percutaneous coronary intervention with adjunctive abciximab in acute coronary syndromes
  1. D J Blackman1,
  2. N R Clarke1,
  3. W P Orr1,
  4. E Wilkinson1,
  5. A Beswick2,
  6. D Coppock1,
  7. D C Sprigings2,
  8. A P Banning1
  1. 1Department of Cardiology, John Radcliffe Hospital, Oxford, UK
  2. 2Department of Cardiology, Northampton General Hospital, Northampton, UK
  1. Correspondence to:
    Dr Adrian P Banning, Department of Cardiology, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK;

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Early revascularisation improves outcome in patients with non-ST elevation acute coronary syndromes (ACS),1,2 particularly if they are treated with adjunctive glycoprotein (Gp) IIb/IIIa inhibitors.2 However, rates of angiography and revascularisation among patients with ACS in the UK remain among the lowest in Europe.3 One of the principal factors responsible for this underprovision is the lack of available beds in the regional cardiac centre, since standard management usually requires an overnight stay both before and after angiography. As a consequence, many ACS patients admitted to district general hospitals (DGHs) wait for several days or even weeks before transfer to the regional centre. This delay is expensive, and patients are at considerable risk of myocardial infarction or death during this period. We hypothesised that ACS patients likely to have disease amenable to percutaneous coronary intervention (PCI) could be managed by day-case transfer to the regional centre for angiography and PCI. This approach had not been previously thought possible because of concerns over the early mobilisation of patients following femoral puncture (particularly after administration of Gp IIb/IIIa inhibitors), concerns over the safety of early discharge from the regional centre, and because of the problem of coordination of ambulance transport. However, if it proved feasible, such a system could increase the availability and efficiency …

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