Introduction
Prompt primary percutaneous coronary intervention (PPCI) is the preferred treatment for patients presenting with ST-segment elevation myocardial infarction (STEMI).1 Clinical outcomes are better with higher procedural volume2 and the intuitive deduction is that PPCIs should be performed by high-volume, usually large, tertiary hospitals. Provision of 24-hour PPCIs by collaboration of other hospitals such as district general hospitals (DGHs) has not been studied in detail.
Sandwell General Hospital is an acute DGH that provides PPCI service without on-site cardiac surgical facilities to a catchment population of 250,000. The servic