title: Urgent in-patient coronary angiography: a comparison of centres with and without cardiac catheter facilities.
abstract: OBJECTIVE
  To review the referral of patients to a tertiary centre for urgent angiography and to determine if there are differences in invasive treatment strategies for patients with acute coronary syndrome (ACS).
  
  
  METHODS
  There were 2 parts to the study, a retrospective part over 3.5 years from a computerised cardiac laboratory booking data base and a prospective part over 3 months.
  
  
  RESULTS
  There were 1190 urgent in-patient angiograms performed with 499 (42%) admitted initially to the tertiary centre while the remaining 691 (58%) were admitted to district general hospitals (DGH), with no on-site access to a cardiac laboratory, and subsequently transferred to the tertiary centre. Once referred, DGH patients waited longer for their angiogram (2.7 +/- 3.2 vs 2.0 +/- 2.8 days, p < 0.0001). Interestingly, DGH patients appear to spend an average of 4 days in hospital prior to referral for angiography. DGH patients were more likely to have a higher Thrombosis in Myocardial Infarction (TIMI) risk score at presentation and following angiography were more likely to have coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) and less likely to have angiographically normal arteries.
  
  
  CONCLUSIONS
  Our findings are consistent with previous studies demonstrating that access to coronary angiography varies considerably between hospitals. However, we have demonstrated that patients in DGHs wait on average 4 days before referral for coronary angiography suggesting that there may be triage based on initial responses to medical therapy. Further research is needed to determine whether this has a direct effect on outcomes.
authors.affiliation: Department of Cardiology, Western General Hospital, Crewe Road, Edinburgh EH4 2XU.
authors.forename: S J
authors.initials: SJ
authors.lastname: Leslie
authors.forename: P A
authors.initials: PA
authors.lastname: Henriksen
authors.forename: H
authors.initials: H
authors.lastname: Timlin
authors.forename: T
authors.initials: T
authors.lastname: Stanton
authors.forename: J C
authors.initials: JC
authors.lastname: Spratt
authors.forename: M A
authors.initials: MA
authors.lastname: Denvir
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000628:therapy*; D006328:Cardiac Catheterization / Q000191:economics; D017023:Coronary Angiography / Q000191:economics; D017046:Cost Savings; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006767:Hospitals, District / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000628:therapy*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012606:Scotland; D013577:Syndrome; D013997:Time Factors