Table 1

Inclusion criteria for DAP, PLP and CP

DAPPLPCP
Patients with on-going chest pain and with any of the following additional haemodynamic or electrocardiographic features:

  1. Persistent ST depression >1 mm or transient ST elevation

  2. Pathological T-wave inversion in V1–V4

  3. Dynamic T-wave inversion >2 mm in two or more contiguous leads

  4. Haemodynamic (eg, sustained hypotension >15 min, pulmonary oedema, heart failure) or electrical (eg, sustained ventricular tachycardia or fibrillation) instability thought to be due to cardiac ischaemia

  1. Admission diagnosis of NSTEACS with chest pain within 24 hours of presentation plus either an elevated blood troponin T or troponin I concentration, or

  2. ECG changes compatible with ischaemia (defined as ST-segment depression ≥1 mm or T-wave inversion ≥2 mm in two contiguous leads, or biphasic ST/T-wave segments indicative of a critical stenosis in the left anterior descending artery)

  3. Patients subsequently fast-tracked for early transfer for coronary angiography

Patients admitted either via the ED, GP referrals or from local DGH medical departments with suspected NSTEACS and high-risk features as per Pan-London high-risk pathwayPatients not appropriately triaged and undergo conventional (delayed) angiography

  • CP, conventional pathway; DAP, direct access pathway; DGH, district general hospital; ED, emergency department; NSTEACS, non-ST-elevation myocardial infarction acute coronary syndrome; PLP, pan-London high-risk ACS pathway.