Background National Institute of Clinical Excellence (NICE) guidelines suggest that patients with intermediate/high-risk non-ST elevation myocardial infarction (NSTEMI) or unstable angina (UA) should undergo invasive coronary angiography within 72-hours of presentation to hospital. Timely angiography and possible percutaneous coronary intervention are associated with reduced mortality and cardiovascular morbidity. The aim of this study was to measure door-to-balloon times for patients admitted with NSTEMI/UA, and to determine the proportion of patients who underwent coronary angiography within the 72-hour time target. If the 72-hour time target was exceeded, reasons for delay were explored.

Methods We performed a retrospective analysis on all patients who underwent an invasive angiogram between July 2022 and December 2022 at Watford General Hospital. Door-to-balloon times were calculated as time of admission, to time of angiography. In patients who had a door-to-balloon time of greater than 72 hours, reasons for delay were explored. Patients presenting with ST-elevation myocardial infarction, and those who suffered a cardiac arrest were excluded from analysis.

Results One-hundred and fifty-nine patients were included in the final analysis. The mean age of the cohort was 64.5 years. Median time for door-to-balloon was 48.1 hours. The target time of 72-hours was achieved in 73.6% of patients. Forty-two patients underwent an angiogram more than 72-hours after admission. In these patients, 64% were deemed to be medically unstable, 31% were delayed due to lack of available angiogram slots/bed capacity and 5% were deemed to be low-risk ACS.

Conclusion The door-to-balloon time target of 72-hours has not always been delivered in patients presenting with a NSTEMI or UA, and there appears to be several reasons for delayed angiography. Lack of angiogram slots due to bed capacity issues, particularly with winter pressures has been highlighted as an important reason for delay. Measures need to be taken to improve compliance with the national 72-hour time target.

Conflict of Interest nil