Key result
In this registry of NSTE-ACS patients presenting at non-PCI centres, 51.4% of high-risk patients underwent angiography at a non-PCI centre, and same-day transfer occurred in only one-quarter.
Why the study?
ESC guidelines recommend same-day transfer to a PCI centre for high-risk NSTE-ACS patients, but treatment patterns at non-PCI centres and the logistical consequences of adopting this strategy were unclear.
What are the treatment patterns and logistical consequences of adopting same-day transfer to PCI centres for NSTE-ACS patients presenting at non-PCI centres?
Observational (n=871)
Yes
What are the treatment patterns and logistical consequences of adopting same-day transfer to PCI centres for NSTE-ACS patients presenting at non-PCI centres?
Non-selective adoption of guideline-recommended same-day transfer for high-risk NSTE-ACS patients from non-PCI to PCI centers would significantly increase logistical burdens by transferring many patients who ultimately receive only medical therapy.
Registry data indicate selective transfer may curb unnecessary logistics in NSTE-ACS; leaves open whether universal same-day transfer improves outcomes or strains systems.
BACKGROUND: European Society of Cardiology (ESC) guidelines recommend same-day transfer to a percutaneous coronary intervention (PCI) centre for angiography in high-risk (ESC-HR) patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). We describe the treatment patterns of NSTE-ACS patients presenting at non-PCI centres and evaluate the logistical consequences of adopting same-day transfer. METHODS: From August 2016 until January 2017, all consecutive NSTE-ACS patients presenting at 23 non-PCI centres in the Netherlands were recorded. We built an online case report form in collaboration with the National Cardiovascular Database Registry to collect information on risk stratification by the attending physician, timing and location of angiography, and treatment. RESULTS: We included 871 patients (mean age 69.1 ± 12.8). 55.8% were considered ESC-HR. Overall, angiography at non-PCI centres was 55.1% and revascularisation was 54.1%. Among ESC-HR patients, angiography at non-PCI centres was 51.4% and revascularisation was 54.9%. Angiography <24 h was 55.6% in patients with angiography at a non-PCI centre and 74.3% in patients with angiography at a PCI-centre. Assuming patients would receive similar treatment, adoption of same-day transfer would increase transfers of ESC-HR patients who undergo PCI (44.3%), but also increases transfers of medically treated patients (36.2%) and patients awaiting coronary bypass artery grafting (9.1%). CONCLUSIONS: In this registry of NSTE-ACS patients at non-PCI centres, the majority of ESC-HR patients underwent angiography at a non-PCI centre. Same-day transfer occurred in one-quarter of the ESC-HR patients, despite guideline recommendation. Nonselective adoption of same-day transfer to a PCI centre would increase transfers of ESC-HR patients who undergo PCI, however, equally increases transfers of patients who are medically treated.
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Hoedemaker et al. (2019) conducted an observational in Non-ST-elevation acute coronary syndrome (NSTE-ACS) (n=871). Presentation at non-PCI centres was evaluated on Angiography at non-PCI centres among ESC high-risk patients. In this registry of NSTE-ACS patients presenting at non-PCI centres, 51.4% of high-risk patients underwent angiography at a non-PCI centre, and same-day transfer occurred in only one-quarter.
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