{
  "abstract": "Introduction Acute coronary syndromes which encompass ST elevation myocardial infarction, non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA) are amongst the leading causes of death in the UK. NSTEMIs/UA are associated with a significant risk of long-term mortality and other major adverse cardiovascular events, underscoring the importance of timely, appropriate management of patients presenting with these. Current NICE guidelines (CG185) recommend that all patients with NSTEMI/UA should be offered coronary angiography (CAG), and follow-on percutaneous coronary intervention (PCI) within 72 hours of admission to hospital, depending on their risk of adverse cardiovascular events.Thus, we aimed to (i) identify the proportion of admitted patients that underwent CAG within the stipulated 72 hour time-frame and (ii) determine whether presentation on a particular day of the week impacted this.Methods All NSTEMI/UA patients admitted to Queen Elizabeth Hospital Birmingham between January 2022 and June 2022 were identified and retrospectively evaluated to confirm their admission date, diagnosis and management. The outcome assessed was time to CAG defined as the difference between the time of procedure and time of admission. Patients were further stratified according to the day of admission and corresponding times to CAG were determined.Results A total of 180 patients were identified. Of these, 153 patients (85%) had CAG within 72 hours and 27 patients (15%) received CAG beyond 72 hours. The median time to CAG was 28.57 [IQR 29.24] hours. 100% of patients admitted on a Sunday received CAG within 72 hours whereas only 69% of patients admitted on a Friday met this target. The odds of receiving CAG within 72 hours were 4-times lower when admitted on a Friday (OR 4.43 [95% CI 1.11 - 17.72]) or Saturday (OR 3.87 [95% CI 0.73 - 20.35]), compared to a Monday (median time to CAG – 67.82 [IQR 70.57] hours and 53.59 [IQR 38.76] hours vs. 28.57 [IQR 29.24] hours respectively). The median time to CAG was shortest when admitted on a Tuesday (22.20 [IQR 29.29]) and Wednesday (22.22 [IQR 15.75]).Abstract 2-013 Table 1Number of NSTEMI/UA patients receiving coronary angiography (CAG) within 72 hours according to the day of the week Day Total admitted N CAG <72 hours N (%) Odds Ratio (95% CI ) Median Time, Hours (IQR) Monday 3229 (91.0)Reference28.57 (29.24) Tuesday 3129 (94.0)0.67 (0.1 – 0.429)22.20 (29.29) Wednesday 3231 (97.0)0.31 (0.03 – 3.17)22.22 (15.75) Thursday 2620 (78.0)2.9 (0.65 – 12.98)24.26 (22.27) Friday 3524 (69.0)4.43 (1.11 – 17.72)67.82 (70.57) Saturday 1410 (71.0)3.87 (0.73 – 20.35)53.59 (38.76) Sunday 1010 (100.0)026.06 (11.93) Total 180153 (85.0)- 28.57 (29.24)Abstract 2-013 Figure 1Proportion of patients that received coronary angiography within 72 hours and beyond 72 hours stratified according to the day of admissionAbstract 2-013 Figure 2Forest plot demonstrating the effect of the day of admission on the likelihood of receiving coronary angiography within 72 hoursConclusion Patients admitted towards the latter part of the working week were less likely to meet the 72-hour target for CAG, highlighting a need for reinforcement of clinical guidelines amongst healthcare professionals, work streams that will enable prioritisation of these patients and enhanced lab space/services during the week to deliver CAG in a timely manner. Further investigation is also required to determine other factors that may be contributing to the delays.",
  "authors": [
    {
      "affiliations": [
        "College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TH"
      ],
      "name": "Ameenathul M Fawzy"
    },
    {
      "affiliations": [
        "Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2GW"
      ],
      "name": "Shammi Khanom"
    },
    {
      "affiliations": [
        "Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2GW"
      ],
      "name": "Mohamed Rezki"
    },
    {
      "affiliations": [
        "College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TH"
      ],
      "name": "Anthony Mechery"
    },
    {
      "affiliations": [
        "College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TH"
      ],
      "name": "Nicky Mortimer"
    },
    {
      "affiliations": [
        "College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TH",
        "Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT"
      ],
      "name": "Sohail Q Khan"
    }
  ],
  "title": "2-013 Impact of admission day on time to coronary angiography in acute coronary syndromes",
  "uid": "31b420c0-1a42-5dee-bf3f-59263574ffc8"
}