Delay to ICA for patients with NSTEMI admitted to hospitals without cardiac catheterisation facilities in SE Scotland

National Institute for Health and Care Excellence (NICE) guidance recommends routine early inpatient invasive coronary angiography (ICA) for patients presenting with non-ST-elevation acute myocardial infarction acute coronary syndrome (NSTEMI-ACS) within 72 hours of hospital admission. For patients admitted to hospitals without invasive cardiac facilities, completing interhospital transfer and investigation within this timeframe is challenging. This retrospective cohort study evaluated factors influencing time to ICA, diagnosis and treatment allocation decisions in 4,087 NSTEMI-ACS patients referred from five district general hospitals to the Royal Infirmary of Edinburgh over four years. The mean time from admission to coronary angiography was 5.0 ± 3.0 days, with the majority waiting longer than the 72-hour NICE target. Admission towards the end of the week, defined as Wednesday to Saturday, was associated with longer delay. Coronary revascularisation was not required in 34% of patients. The presence of obstructive coronary disease and use of coronary revascularisation varied with age and sex, with younger female patients more likely to have normal coronary arteries or mild non-obstructive plaque disease. Use of percutaneous coronary intervention (PCI) varied with supervising consultant operator. These findings highlight disparity between clinical practice and NICE guideline recommendations for NSTEMI-ACS patients admitted to hospitals without invasive cardiac facilities, and highlight the need for the development of treatment pathways that reduce delay and better identify patients who will benefit from coronary revascularisation.