Introduction: Patient risk for adverse events in non-ST-segment myocardial infarction (NSTEMI) depends on procedural characteristics, patients’ comorbidities and clinical setting. We aimed to investigate standardized risk-adjusted periprocedural management for coronary angiographies and evaluate associations of a Standard Operation Procedure (SOP) with in-hospital clinical outcomes. 

Methods: We established pre-procedural risk assessment for cardiac catheterization procedures based on the National Cardiovascular Data Registry (NCDR) risk models at our Heart Center in 2018. Along with pre-procedural risk assessment, standardized post-procedural risk-adjusted safety measures including advanced patient monitoring, the use of vascular closure devices and others were established. We retrospectively evaluated SOP-based risk scoring as well as post-procedural management and in-hospital clinical outcomes for in-hospital mortality, major bleeding (BARC ≥ 3) and acute kidney injury (according to KDIGO definitions) in NSTEMI patients.  

Results: 430 NSTEMI patients presenting with NSTEMI were included (71% male). Overall in-hospital mortality was 3.7%, acute kidney injury was observed in 17.2% and major bleeding in 6.5% of the patients. 207 patients (48.1%) received 1) pre-procedural risk assessment and 2) post-procedural risk-adjusted management (SOP+ group), 223 patients (51.9%) had not received either 1) or 2) (SOP- group). Overall, patients in the SOP- group were more often treated in emergency settings (39.9% (SOP-) vs. 21.7% (SOP+); p<0.001). Baseline characteristics and medical conditions did not differ significantly between groups. In univariate analysis, in-hospital clinical outcomes of mortality (1.4% (SOP+) vs. 5.8% (SOP-); p=0.016), major bleeding (2.9% (SOP+) vs. 9.9% (SOP-); p=0.003) were significantly lower in the SOP+ group, whereas clinical events of acute kidney injury did not differ significantly (14% (SOP+) vs. 20.2% (SOP-); p=0.090). In the multivariate logistic regression analysis with correction for the difference in risk between groups due to emergency settings, major bleedings remained significantly lower in the SOP+ group (p=0.02).

Conclusion: Standardized risk-adjusted peri-procedural management in invasively managed NSTEMI patients was associated with significantly less in-hospital major bleedings.