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Coronary disease & ACSCohort study

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

Circ Cardiovasc IntervPublished

  • Registry analysis (National Cardiovascular Data Registry Chest Pain-MI registry data)
  • Hierarchical logistic regression models
  • median odds ratios, adjusted for patient and site characteristics
  • Inverse probability weighting
Read the original article ↗

Authors' conclusion

Patients with type-1 NSTEMI and higher-risk clinical profiles were not consistently prioritized to undergo early invasive management with substantial variability across hospitals. Invasive management was associated with lower in-hospital mortality compared with conservative treatment. Future randomized studies in the modern percutaneous coronary intervention era are needed to confirm our findings and identify which patients benefit most and when intervention should occur.

Study context

Population
Patients with type-1 NSTEMI, NCDR Chest Pain-MI registry, 2019–2024patients with type-1 NSTEMI from 541 hospitals
Participants
287,275 patients
Exposure
any invasive strategy versus conservative management

Main finding

As reported in the abstract

Invasive coronary angiography use and timing

Invasive coronary angiography performed

87.1%

Of those with invasive coronary angiography, within 24 hours

56.9%

Among those treated invasively, percutaneous coronary intervention

66.1%

Observational data: associations, not effects.

Further findings

Outcomeweighted odds ratio (95% CI)
In-hospital mortality · lower with invasive strategy; inverse probability weighting0.36 (0.31–0.42)
  • In-hospital mortality: consistent across all baseline risk categories (P interaction <0.001)

Site-level variability in management

Invasive strategy (versus conservative), median odds ratio
2.85 (95% CI, 2.64-3.10]
Early invasive treatment, median odds ratio
1.67 [95% CI, 1.62-1.74]
Weekends/holidays, median odds ratio
1.89 [95% CI, 1.81-1.98]

Original publication

Hospital-Level Variability in NSTEMI Management: Findings From the NCDR Chest Pain-MI Registry. Circ Cardiovasc Interv. Published 7 March 2026. doi:10.1161/circinterventions.126.016534
Read the original article ↗PubMedCite RIS · BibTeX

Summarised from the published abstract; every number is checked against it