Quality standard
Quality statement 3: Coronary angiography and PCI within 72 hours for NSTEMI or unstable angina
Quality statement 3: Coronary angiography and PCI within 72 hours for NSTEMI or unstable angina
Quality statement
Adults with non-ST-segment-elevation myocardial infarction (NSTEMI) or unstable angina who have an intermediate or higher risk of future adverse cardiovascular events who are having coronary angiography (with follow-on percutaneous coronary intervention [PCI] if indicated), have it within 72 hours of first admission to hospital.
Rationale
In people with an intermediate or higher risk of future adverse cardiovascular events, coronary angiography to define the extent and severity of coronary disease, done within 72 hours of admission to hospital, offers advantages over an initial conservative strategy, provided there are no contraindications to angiography (such as active bleeding or comorbidity). Services should provide coronary angiography (with follow-on PCI if indicated) as soon as it offers net clinical benefits; within 72 hours and sooner if possible.
Quality measures
Structure
Evidence of local arrangements to ensure that adults with NSTEMI or unstable angina who have an intermediate or higher risk of future adverse cardiovascular events who are having coronary angiography (with follow-on PCI if indicated), have it within 72 hours of first admission to hospital.
Data source: Local data collection.
Process
a) Proportion of adults with NSTEMI or unstable angina who have an intermediate or higher risk of future adverse cardiovascular events who receive coronary angiography (with follow-on PCI if indicated) within 72 hours of first admission to hospital.
Numerator – the number of people in the denominator receiving coronary angiography (with follow-on PCI if indicated) within 72 hours of admission to hospital.
Denominator – the number of adults with NSTEMI or unstable angina with an intermediate or higher risk of future adverse cardiovascular events having coronary angiography (with follow-on PCI if indicated).
Data source: Local data collection.
What the quality statement means for different audiences
Service providers (cardiac service providers) ensure that local pathways are in place for adults with NSTEMI or unstable angina who have an intermediate or higher risk of future adverse cardiovascular events, who are having coronary angiography (with follow-on PCI if indicated) to have it within 72 hours of first admission to hospital.
Healthcare professionals ensure that adults with NSTEMI or unstable angina who have an intermediate or higher risk of future adverse cardiovascular events, who are having coronary angiography (with follow-on PCI if indicated), have it within 72 hours of first admission to hospital.
Commissioners (clinical commissioning groups) ensure that they commission services with the capacity and expertise to ensure that adults with NSTEMI or unstable angina who have an intermediate or higher risk of future adverse cardiovascular events who are having coronary angiography (with follow-on PCI if indicated), have it within 72 hours of first admission to hospital.
Adults with heart conditions called NSTEMI and unstable angina and a medium or higher risk of another heart attack who are having a test called coronary angiography (and treatment to improve blood flow to the heart if needed), have this within 72 hours of first being admitted to hospital.
Source guidance
Acute coronary syndromes. NICE guideline NG185 (2020), recommendation 1.2.13
Definitions of terms used in this quality statement
Intermediate or higher risk of future adverse cardiovascular events
A predicted 6-month mortality above 3.0%. [NICE's guideline on acute coronary syndromes, recommendation 1.2.13]