Guideline-conforming timing of invasive management in troponin-positive or high-risk ACS without persistent ST-segment elevation in German chest pain units. Urban university maximum care vs. rural regional primary care.

Aim. This study aimed to analyze guideline adherence in the timing of invasive manage- ment for myocardial infarction without per- sistent ST-segment elevation (NSTEMI) in two exemplary German centers, comparing an ur- ban university maximum care facility and a rural regional primary care facility. Methods. All patients diagnosed as having NSTEMI during 2013 were retrospectively en- rolled in two centers: (1) site I, a maximum care center in an urban university setting, and (b) site II, a primary care center in a rural re- gional care setting. Data acquisition includ- ed time intervals from admission to invasive management, risk criteria, rate of interven- tion, and medical therapy. Results. The median time from admission to coronary angiography was 12.0 h (site I) or 17.5 h (site II; p = 0.17). Guideline-adher- ent timing was achieved in 88.1 % (site I) or 82.9 % (site II; p = 0.18) of cases. Intervention rates were high in both sites (site I—75.5 % vs. site II—75.3 %; p = 0.85). Adherence to recommendations of medical therapy was high and comparable between the two sites. Conclusion. In NSTEMI or high-risk acute coronary syndromes without persistent ST- segment elevation, guideline-adherent tim- ing of invasive management was achieved in about 85 % of cases, and was comparable between urban maximum and rural primary care settings. Validation by the German Chest Pain Unit Registry including outcome analy- sis is required.