title: Local provision of percutaneous coronary intervention increases stenting rates and reduces length of hospital stay in remote regional centre.
abstract: BACKGROUND
  An early invasive strategy with follow-on percutaneous coronary intervention (PCI) is recommended in the management of high risk acute coronary syndromes (ACS). This article aimed to assess the impact of a new PCI service in a remote population.
  
  
  METHODS
  The study compared patient treatment pre- and post-introduction of the PCI service in a remote regional centre. Patients were identified using ICD discharge code during two 12 week periods ('pre' and 'post' introduction of the new PCI service). Further data was obtained from a catheter laboratory database, electronic patient management systems and clinical notes. Non-parametric statistical tests were used.
  
  
  RESULTS
  There were 182 patients in the pre-PCI group and 204 in the post-PCI group. There were no demographic differences between the groups. Patients admitted post service introduction who required active treatment were more likely to have PCI rather than an angiogram only (p = 0.046). Furthermore, patients admitted after the introduction of the PCI service had a shorter period of time from admission to PCI (p = 0.002), were less likely to be transferred to another hospital (p < 0.001), and on average had a shorter hospital stay (p = 0.017).
  
  
  CONCLUSIONS
  A local PCI service in a remote regional centre increased efficiency in the management of patients with ACS with increased rates of PCI, shorter waiting times, reduced requirement for hospital transfer, and shorter length of stay. Nevertheless, many patients still required transfer to other centres. Therefore, maintaining links with other regional centres with clear patient pathways are necessary to provide optimal ACS care to all patients in a rural area.
authors.affiliation: School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland, UK. stephanie.bruce@nhs.net
authors.forename: Stephanie
authors.initials: S
authors.lastname: Bruce
authors.forename: Jamie A L
authors.initials: JA
authors.lastname: Smith
authors.forename: Iain
authors.initials: I
authors.lastname: Atherton
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Leslie
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data* / Q000639:trends; D019035:Rural Health Services / Q000706:statistics & numerical data*; D018709:Statistics, Nonparametric; D015607:Stents