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; [Leitlinienadhärentes Timing der invasiven Diagnostik bei NSTEMI und Hochrisiko-NSTE-ACS in deutschen Chest Pain Units: Universitäre Versorgung im städtischen Bereich vs. Regel- und Schwerpunktversorgung im ländlichen Bereich]

Aim: This study aimed to analyze guideline adherence in the timing of invasive management for myocardial infarction without persistent ST-segment elevation (NSTEMI) in two exemplary German centers, comparing an urban university maximum care facility and a rural regional primary care facility. Methods: All patients diagnosed as having NSTEMI during 2013 were retrospectively enrolled 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 regional care setting. Data acquisition included time intervals from admission to invasive management, risk criteria, rate of intervention, 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-adherent 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 timing 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 analysis is required. © 2015, Urban & Vogel.