1. PCI Models: Gloucestershire Nick West Consultant Cardiologist

2. MY CONFLICTS OF INTEREST ARE: Advisory Board:Nycomed, Astrazeneca, Schering-Plough Speaker Fees: Nycomed, Astrazeneca, Schering Plough, MSD Sponsorship: Boston Scientific, Nycomed, Medtronic, Abbott Vascular Research Grants: Bristol-Myers Squibb

3. Glos Hosps NHS Foundation Trust 650,000 population 2 DGHs 2 Cath labs 3 Interventionalists Remote from Tertiary centres

4. Who should go to a surgical centre? Viewpoints:  Patients  Trusts  Cardiologists A local service

5. PCI in Gloucestershire: Inpatient vs. Elective work. Cases/year (n)

6. Possible issues Out-of-hours/on-call Specialist techniques/devices ‘High risk’ cases Research studies

7. Out of hours/on-call Can your service offer PCI 24/7? Are you geared up for emergencies? How many interventionalists are there? Is there an on-call rota? Do the rest of the cath lab staff want this? Is it cost-effective? Network solutions

8. What is ‘high risk’?

9. PCI in Gloucestershire: Inpatient vs. Elective work. Cases/year (n)

10. How do we measure up? Inhospital MACE (%) Grayson et al. Heart 2006; 92: 658-663

11. Research Studies Should offsite centres be allowed to join in?

12. UC200603565 EE. Data and images on file at Medtronic Inc. CE Marked. Not available for use or distribution in the USA. Use, reproduction and distribution only by permission of Medtronic, Inc. E-5 Registry: the ‘Real World’ Final UK recruitment: Cheltenham General 100 Leeds General65 Royal Victoria, Belfast51 St. Georges, London 46 James Cook, M’boro 36 QE, Birmingham35 Derriford, Plymouth 18 Barts, London14 Nottingham City 13 Walsgrave, Coventry 13 London Chest 12 PC Biomimetic polymer Reduced platelet deposition Rapid and complete drug delivery Highly lipophillic limus analogue Noninflammatory response and rapid endothelialization *

13. Possible issues Out-of-hours/on-call Specialist techniques/devices ‘High risk’ cases Research studies ? X X X

14. Summary Few good arguments to limit offsite work Can we all live together happily ever after? Acknowledgements Rafe Chamberlain-Webber Zafar Khan All cath lab staff at CGH