2-028 Time from admission to percutaneous coronary intervention for patients with acute coronary syndromes admitted under medicine at a large tertiary centre. Can an outpatient ‘virtual ward’ improve emergent cath lab capacity for those that need it most?

Introduction Current evidence supports the stratification of non-ST-segment elevation acute coronary syndromes (NSTE-ACS) into low and high-risk groups, with selective provision of emergent (Method We retrospectively collected data from the electronic patient record on all patients admitted under medicine between October 2023 and October 2024 with a NSTE-ACS. Data collected included GRACE score, presence of ongoing chest pain, haemodynamic instability, new heart failure, ventricular arrhythmias or ST segment changes on ECG as well as time from admission to invasive coronary angiography. A Mann-Whitney U test was used to compare time from admission to invasive coronary angiography between low and high-risk groups. Results Between October 2023 and October 2024, 99 patients were admitted under medicine with NSTE-ACS, 74 of whom underwent PCI (table 1). This predicts a weekly requirement for emergency PCI for 1.42 patients. 53 of these patients met criteria for low-risk NSTE-ACS (table 2). Mean time to PCI was 3.81 days for all patients, 3.55 days for low-risk and 4.48 days for high-risk patients, though the difference between groups was not statistically significant (P=0.103) (figure 1). 44.6% of patients with a GRACE score ≥3% underwent PCI within 72 hours of admission. Mean length of stay for low-risk patients was 9.2 days. Establishment of an outpatient 'virtual ward' for low-risk cases, with scheduling into the elective cath lab lists based on estimated capacity, would eliminate 53 cases from the demand for emergency PCI, an estimated 1 case per week. This would reduce the demand placed by medicine on the emergency PCI service by 71.6%. If this low-risk group were discharged to a 'virtual ward' at 48 hours after admission this pathway would also create an estimated 384 bed days per year. Conclusion Time from admission to percutaneous coronary intervention averages 3.81 days for patients admitted under medicine at our large tertiary centre. 71.6% of these patients would be suitable for an outpatient 'virtual ward', reducing the burden on the emergency PCI service and creating an estimated 384 bed days per year. Establishment of this pathway has the potential to improve time to PCI for high-risk cases as well as improve patient flow.