LAUSR

Background: Outcomes from intervention in patients with ACS are time dependent Patients admitted to non-PCI hospitals often experience inequitable access to PCI and poor timelines Elderly patients in particular are at higher risk following ACS We audited outcomes in two rural hospitals with and without onsite PCI access Method: Retrospective data was collected for patients presenting with ACS to Hawke's bay hospital (HB) and PCI-capable Nelson hospital (NM) between February 2017 - Jan 2018 Patients were divided by age group Percentage of intervention, door-to-intervention time in days (DIT), length of stay in days (LOS) and adverse outcomes were analysed Results: There was no significant difference in mean age (68±3 6 vs 70±3 3) and GRACE score (116±9 5 vs 124±8 6) between HB (n=249) and NM (n=256) HB patients had less intervention (65% vs 71%, <75 and 38% vs 45%, ≥75), longer DIT (6 0±3 0 vs 1 0±0 5, <75 and 4 8±3 3 vs 1 3±1 0, ≥75) and longer LOS (7 8±3 2 vs 3 0±1 2, <75 and 7 1±3 4 vs 4 7±3 0 ≥75) compared to NM patients (p<0 001) Overall MACCE in HB (18% vs 13%, <75 and 35% vs 31%, ≥75) and mortality at 18 months (9% vs 6%, <75 and 29% vs 20%, ≥75) was also higher Conclusion: On-site PCI availability improves timely access to PCI and was associated with significantly lower mortality and MACCE in this unadjusted raw data The elderly appeared to benefit more with an associated substantially lower mortality