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. 2019 Apr;27(4):191-199.
doi: 10.1007/s12471-019-1229-2.

Treatment patterns of non-ST-elevation acute coronary syndrome patients presenting at non-PCI centres in the Netherlands and possible logistical consequences of adopting same-day transfer to PCI centres: a registry-based evaluation

N P G Hoedemaker  1 , P Damman  2 , H A Bosker  3 , P W Danse  3 , A H Liem  4 , B Geerdes  5 , H van Laarhoven  6 , R J de Winter  7 ; NVVC NSTEMI-ACS project group
Affiliations

Treatment patterns of non-ST-elevation acute coronary syndrome patients presenting at non-PCI centres in the Netherlands and possible logistical consequences of adopting same-day transfer to PCI centres: a registry-based evaluation

N P G Hoedemaker et al. Neth Heart J. 2019 Apr.

Abstract

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.

Keywords: Non-ST-elevation acute coronary syndrome; PCI; coronary angiography; same-day transfer.

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Conflict of interest statement

N.P.G. Hoedemaker, P. Damman, H.A. Bosker, P.W. Danse, A.H. Liem, B. Geerdes, H. van Laarhoven, R.J. de Winter and The NVVC NSTEMI-ACS project group declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A map of the Netherlands with the participating 23 non-PCI centres and all 30 PCI centres
Fig. 2
Fig. 2
Proportion of ESC risk categories in all 871 NSTE-ACS presentations
Fig. 3
Fig. 3
Differences in percentage of each ESC risk category displayed for patients undergoing angiography at non-PCI centres (non-transferred) and patients undergoing angiography at PCI centres (transferred)
Fig. 4
Fig. 4
The current situation (left bar) and possible logistical consequences of adopting same-day transfer to undergo angiography at a PCI centre, as recommended by the 2015 NSTE-ACS ESC guidelines (right bar) (PCI percutaneous coronary intervention, CABG coronary artery bypass grafting, NSTE-ACS non-ST-elevation acute coronary syndrome, ESC European Society of Cardiology)
See this image and copyright information in PMC

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