Hospital-Level Variability in NSTEMI Management: Findings From the NCDR Chest Pain-MI Registry.

Area of Science:

• Cardiology
• Health Services Research

Background:

• Guidelines recommend invasive management for non-ST-elevation myocardial infarction (NSTEMI).
• Significant variability exists in applying these recommendations across hospitals.
• Lack of standardized clinical pathways contributes to uncertainty in real-world NSTEMI practice.

Purpose of the Study:

• To describe hospital-level variability in the use and timing of invasive angiography for NSTEMI.
• To assess the association between invasive management strategies and in-hospital outcomes for NSTEMI patients.

Main Methods:

• Analysis of NCDR Chest Pain-MI registry data (2019-2024) for patients with Type-1 NSTEMI.
• Hierarchical logistic regression to model hospital-level variability in management (Median Odds Ratios).
• Inverse probability weighting to estimate associations between treatment strategy and outcomes.

Main Results:

• Invasive coronary angiography was performed in 87.1% of 287,275 NSTEMI patients; 56.9% within 24 hours.
• Significant site-level variability observed in invasive strategy adoption and early treatment timing.
• Invasive management was associated with significantly lower in-hospital mortality (weighted OR 0.36).

Conclusions:

• Patients with Type-1 NSTEMI, particularly high-risk individuals, are not consistently prioritized for early invasive management.
• Substantial hospital-level variability exists in NSTEMI invasive treatment strategies.
• Invasive management is linked to reduced in-hospital mortality, warranting further research into optimal patient selection and timing.