Influence of Hospital Type on Treatment and Prognosis in Patients With Non-ST Elevation Acute Coronary Syndrome

Introduction and objectives Clinical practice guidelines on non-ST-segment elevation acute coronary syndrome (NSTEACS) do not take either hospital infrastructure or the availability of a catheterization laboratory into account. The aim of this study was to determine the influence of hospital type, either with or without a catheterization laboratory, on treatment and medium-term prognosis in patients with NSTEACS. Methods The GYSCA multicenter study (covering 15 hospitals) investigated the implementation of clinical practice guidelines in patients with NSTEACS at 6 hospitals with catheterization laboratories (ie, tertiary-care hospitals; THs) and nine without (ie, secondary-care hospitals; SHs). Patients were assessed clinically at hospital discharge and after 3 and 12 months. Results In total, 1133 consecutive patients were recruited: 599 (52.9%) in THs and 534 (47.1%) in SHs. The use of specific class-I interventions (ie, aspirin, clopidogrel, beta-blockers, angiotensin-converting enzyme inhibitors, and statins) was more common in THs ( P P P Conclusions Patients admitted for NSTEACS to a hospital without a catheterization laboratory were managed less invasively and their drug treatment was less likely to have been modified to match guideline recommendations. In addition to other well-known prognostic factors, hospital type can also have an influence on patient outcomes.