74 Door-to-balloon times in patients presenting with non-ST elevation myocardial infarction or unstable angina: a retrospective observational study
Bibliographic record
Abstract
<h3>Background</h3> 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. <h3>Methods</h3> 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. <h3>Results</h3> 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. <h3>Conclusion</h3> 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. <h3>Conflict of Interest</h3> nil
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".