title: 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.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, Arnsberg Medical Center, Stolte Ley 5, 59759, Arnsberg, Germany. f.breuckmann@klinikum-arnsberg.de.
authors.forename: F
authors.initials: F
authors.lastname: Breuckmann
authors.affiliation: Department of Cardiology, Arnsberg Medical Center, Stolte Ley 5, 59759, Arnsberg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Remberg
authors.affiliation: Department of Cardiology, Arnsberg Medical Center, Stolte Ley 5, 59759, Arnsberg, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Böse
authors.affiliation: Department of Angiology, Arnsberg Medical Center, Arnsberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Lichtenberg
authors.affiliation: Department of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Kümpers
authors.affiliation: Department of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Pavenstädt
authors.affiliation: Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Waltenberger
authors.affiliation: Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Fischer
mesh_terms: D000046:Academic Medical Centers / Q000592:standards / Q000706:statistics & numerical data*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D005060:Europe; D005260:Female; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D015995:Prevalence; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data; D012189:Retrospective Studies; D019035:Rural Health Services / Q000592:standards / Q000706:statistics & numerical data*; D000072657:ST Elevation Myocardial Infarction; D015996:Survival Rate; D061665:Time-to-Treatment / Q000592:standards / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood
chemical_list: D015415:Biomarkers; D014336:Troponin
keywords: Acute coronary syndrome; Chest pain unit; Coronary angiography; Guideline adherence; Non-ST-segment elevation myocardial infarction; Timing