Comparative Profiles and Invasive Management of Patients With High-Risk Non-ST Elevation Acute Coronary Syndromes in Two University Hospitals From Romania and Germany.

Abstract

Background: Regional differences in cardiovascular disease (CVD), prevalence, and outcomes in the European population have been reported. Although current European Society of Cardiology guidelines recommend invasive coronary angiography (ICA) <24 hours from diagnosis in high-risk non-ST elevation acute coronary syndromes (NSTE-ACS), overall management remains heterogenous across Europe.

Study question: What are the differences regarding profiles of patients with high-risk NSTE-ACS and factors associated with timing of ICA in 2 university hospitals from 2 European countries with different prevalence of CVD and different income (University and Emergency Hospital, Bucharest, Romania [RO] and University Hospital, Essen, Germany [GER])?

Study design: Retrospective, observational, all-comers.

Measures and outcomes: All consecutive invasively managed patients with high-risk NSTE-ACS in 2022 were retrospectively identified and analyzed regarding clinical profiles and factors associated with ICA timing in relation to the 24-hour European Society of Cardiology recommended interval.

Results: A total of 587 patients were included: 301 from RO and 286 from GER. RO patients were younger (64.6 vs. 70.6 years, P < 0.001), with higher rates of obesity (P = 0.013), hypertension (P = 0.001), dyslipidemia (P < 0.001), diabetes (P < 0.001), and active smoking (P = 0.019), whereas GER patients had higher rates of previous myocardial revascularization (P < 0.001), chronic respiratory disease (P < 0.001), sleep apnea (P < 0.001), thyroid disorders (P < 0.001), and neoplasia (P = 0.036). About 68.1% patients from RO versus 74.8% from GER underwent ICA <24 hours (P = 0.006). Transfers and admission during cathlab on-hours in RO, diagnosis of myocardial infarction, and typical angina in GER were associated with ICA <24 hours (all P < 0.05).

Conclusions: High-risk NSTE-ACS patient profiles mirrored overall regional CVD patterns. Compared to the German hospital, patients in the Romanian hospital had a worse CVD risk factor profile at a younger age, lower previous myocardial revascularization, and potentially underdiagnosed comorbidities. Health care system organization and hospital logistics largely influenced ICA timing in the Romanian hospital, opposite mainly patient characteristics in the German hospital.