How long do acute coronary syndrome patients wait for reperfusion, diagnostic coronary angiography and surgical revascularisation?

AIM: To describe the components of in-hospital waiting time to investigation and management in patients with acute coronary syndromes (ACS) admitted to the Middlemore Hospital (MMH) Coronary Care Unit.

METHOD: We examined the time to (1) reperfusion therapy in ST-elevation myocardial infarction (STEMI), (2) coronary angiography in ACS, and (3) surgical revascularisation. Data was collected prospectively for consecutive patients via the Acute PREDICT ACS registry.

RESULTS: Of 280 STEMI admissions in 2009 and 2010, 101 underwent primary percutaneous coronary intervention. The median door-to-balloon time when performed on site at MMH was 83 minutes (IQR 69-101 minutes) compared with 135 minutes (IQR 112-165 minutes) for those transferred after hours to Auckland City Hospital (ACH). Of 2115 ACS admissions between 2007 and 2010 84% underwent inpatient coronary angiography and 69% of these underwent this within 3 days. The strongest predictors of a >3 day delay were advanced chronic kidney disease (odds ratio 3.68, 95% CI 2.08-6.51) and presenting late in the week (odds ratio 2.85, 95% CI 2.30-3.54). 329 patients (16%) underwent coronary artery bypass graft surgery (CABG). The median time from admission to inpatient CABG was 13 days and from discharge to outpatient CABG was 155 days. Of ACS patients referred for outpatient surgery in the public sector 38% were readmitted with further ACS whilst waiting.

CONCLUSION: Important delays were identified across the spectrum of post-admission care for ACS patients potentially impacting on both patient outcomes and the cost of care. Active quality improvement programmes to reduce delays are required.