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The article focuses on a study related to percutaneous coronary intervention (PCI) that is the optimal reperfusion strategy for acute STEMI. A major shift in cardiology practice will be necessary to provide a countrywide primary PCI service for Great Britain. Researchers sought to examine the feasibility and impact of delivering a daytime primary PCI service in a large district hospital admitting 250 STEMIs per year. The centre has a single cardiac catheter laboratory with a throughput of 1650 diagnostic and 600 interventions procedures in 2002 covered by off-site cardiac surgery.

A descriptive follow-up study of a hospital based chest pain clinic set up for the identification of the patients with unstable angina and acute myocardial infarction. The clinic is staffed by a cardiologist-in-training seeing patients on the day of referral by general practitioners because of acute chest pain of unclear origin. Over 6 months, 174 patients were assessed. 34 (19.5%) had a diagnosis of unstable angina or acute myocardial infarction (acute coronary syndrome), 52 (30%) had non-acute cardia pain and 88 (50.5%) had non-cardiac pain. Of those with a clinical diagnosis of acute coronary syndrome, 5 were subsequently shown to have non-cardiac, 8 had acute myocardial infarction and 21 had unstable angina. One month follow-up information was available on 136 of 139 (98%) patients not admitted to hospital via the chest pain clinic. 3 were admitted to hospital within the following 4 weeks because of myocardial infarction in 1 and unstable angina in 2. One year follow-up was available on 118 patients. One patient was admitted with unstable angina 6 months later and one patient sustained sudden cardiac death 3 months later. In the absence of the clinic, general practitioners would have arranged hospital admission for 66 (48%) or assessment in the emergency department for 13 (9%) of those discharged. Almost all general practitioners found the service helpful. The chest pain clinic was well received and provided an efficient method of identifying patients with acute coronary syndrome and minimised unnecessary admissions.

In a series of 129 patients having coronary angioplasties in St. James's Hospital in 1989, the average age was 54.8 (30-77 years). There were 102 (79%) men and 27 (21%) females. Clinical indications were unstable angina 62, stable angina 26, post myocardial infarction 39 and asymptomatic ischaemia 2. The distribution of coronary disease was single vessel 62%, double vessel 28%, triple vessel 7% and previous coronary bypass surgery 3%. Only 10 patients had more than one vessel dilated. Primary success was achieved in 119 (92%), there were no deaths, 3 patients had abrupt closure of the vessel during angioplasty and sustained a nonfatal myocardial infarction, 1 patient required urgent bypass surgery and 2 patients had peripheral vascular complications requiring surgery. There were 6 failed angioplasties, 4 of which had chronic total occlusion. At a mean follow-up of 5.3 months, 85 patients had no symptoms, 34 had angina, 2 developed myocardial infarction and 1 died suddenly at 5 months. Repeat angiography was performed in 96 (79%) patients. At follow-up, no symptoms were present in 69% of those with single vessel disease and 70% of multivessel disease. Of those who had more than one vessel dilated in multivessel disease, 80% were asymptomatic (P = NS). There were 11 patients with initial total occlusion at presentation, 4 had failed angioplasties, 5 recurrent angina of which 4 reoccluded and 1 restenosed and only 2 were asymptomatic and without restenosis. Angioplasty was performed with primary success (92%) and follow up results (70% asymptomatic). Those with single or multivessel disease had similar clinical outcome, favouring the use of target vessel angioplasty. Long term results following angioplasty of chronic total occlusions were poor and suggests the need for additional treatment.