Presentation, care, and outcomes of patients with NSTEMI according to World Bank country income classification: the ACVC-EAPCI EORP NSTEMI Registry of the European Society of Cardiology
Authors: Nadarajah Ramesh , Ludman Peter , Laroche Cécile , Appelman Yolande , Brugaletta Salvatore , Budaj Andrzej , Bueno Hector , Huber Kurt , Kunadian Vijay , Leonardi Sergio , Lettino Maddalena , Milasinovic Dejan , Gale Chris P ,   the NSTEMI investigator group, Vahanian A , Budaj A , Dagres N , Danchin N , Delgado V , Emberson J , Friberg O , Gale C P , Heyndrickx G , Iung B , James S , Kappetein A P , Maggioni A P , Maniadakis N , Nagy K V , Parati G , Petronio A-S , Pietila M , Prescott E , Ruschitzka F , Van de Werf F , Weidinger F , Zeymer U , Gale C P , Beleslin B , Budaj A , Chioncel O , Dagres N , Danchin N , Emberson J , Erlinge D , Glikson M , Gray A , Kayikcioglu M , Maggioni A P , Nagy K V , Nedoshivin A , Petronio A-P , Roos-Hesselink J W , Wallentin L , Zeymer U , Popescu B A , Adlam D , Caforio A L P , Capodanno D , Dweck M , Erlinge D , Glikson M , Hausleiter J , Iung B , Kayikcioglu M , Ludman P , Lund L , Maggioni A P , Matskeplishvili S , Meder B , Nagy K V , Nedoshivin A , Neglia D , Pasquet A A , Roos-Hesselink J W , Rossello F J , Shaheen S M , Torbica A , Gale Christopher Peter , Ludman Peter F , Lettino Maddalena , Bueno Hector , Huber Kurt , Leonardi Sergio , Budaj Andrzej , Milasinovic Dejan , Brugaletta Salvatore , Appelman Yolande , Kunadian Vijay , Mahmeed Wael Abdul Rahman Al , Kzhdryan Hovhannes , Dumont Carlos , Geppert Alexander , Bajramovic Nirvana Sabanovic , Cader Fathima Aaysha , Beauloye Christophe , Quesada Daniel , Hlinomaz Ota , Liebetrau Christoph , Marandi Toomas , Shokry Khaled , Bueno Héctor , Mansourati Jacques , Gale Chris P , Maisuradze David , Sinanis Theodoros , Dharma Surya , Orvin Katia , Sinha Ajay , Farhan Hasan Ali , Sadeghipour Parham , Gudmundsdottir Ingibjorg , Indolfi Ciro , Kitai Takeshi , Mirrakhimov Erkin , Gustiene Olivija , Philippe François , Erglis Andrejs , Popovici Mihail , Kalpak Oliver , Dagva Mungunchimeg , Xuereb Robert George , Ahmad Wan Azman Wan , Appelman Yolande , Nadar Sunil K , Qamar Nadeem , Gierlotka Marek , Monteiro Silvia , Dan Gheorghe-Andrei , Radovanovic Mina , Reznik Elena Vladimirovna , Balghith Mohammed , Mohamed Awad , Cercek Miha , Brozmannová Denisa , Aytekin Vedat , Ingabire Prossie , Alyavi Baxrom , Cartasegna L , Gomez V Nomberto , Beltrano C , Novas V , Dumont C , Balparda H , Cardona M , Cigalini C , Hoyle V , Dámaso E San , Tapia V , Poghosyan K , Mkhitaryan S , Adamyan M , Boyadjian S , Hayrapetyan H , Azaryan K , Tadevosyan M , Poghosyan H , Kzhdryan H , Vardanyan A , Huber K , Geppert A , Ahmed A , Weidinger F , Derntl M , Hasun M , Schuh-Eiring T , Riegler L , Haq M M , Cader F A , Dewan M A-M , Fatema M-E , Hasan A S , Islam M M , Khandoker F , Mayedah R , Nizam S U , Azam M G , Arefin M M , Jahan J , Schelfaut D , De Raedt H , Wouters S , Aerts S , Batjoens H , Beauloye C , Dechamps M , Pierard S , Van Caenegem O , Sinnaeve F , Claeys M J , Snepvangers M , Somers V , Gevaert S , Schaubroek H , Vervaet P , Buysse M , Renders F , Dumoulein M , Hiltrop N , De Coninck M , Naessens S , Senesael I , Hoffer E , Pourbaix S , Beckers J , Dugauquier C , Jacquet S , Malmendier D , Massoz M , Evrard P , Collard L , Brunner P , Carlier S , Blockmans M , Mayne D , Timiras E , Guédès A , Demeure F , Hanet C , Domange J , Jourdan K , Begic E , Custovic F , Dozic A , Hrvat E , Kurbasic I , Mackic D , Subo A , Durak-Nalbantic A , Dzubur A , Rebic D , Hamzic-Mehmedbasic A , Redzepovic A , Djokic-Vejzovic A , Hodzic E , Hujdur M , Musija E , Gljiva-Gogic Z , Serdarevic N , Bajramovic N Sabanovic , Brigic L , Halilcevic M , Cibo M , Hadžibegic N , Kukavica N , Begic A , Iglica A , Osmanagic A , Resic N , Grgurevic M Vucijak , Zvizdic F , Pojskic B , Mujaric E , Selimovic H , Ejubovic M , Pojskic L , Stimjanin E , Sut M , Zapata P Sanchez , Munoz C Gallego , Andrade L A Fajardo , Upegui M P Tobon , Perez L E , Chavarria J , Quesada D , Alvarado K , Zaputovic L , Tomulic V , Gobic D , Jakljevic T , Lulic D , Bacic G , Bastiancic L , Avraamides P , Eftychiou C , Eteocleous N , Ioannou A , Lambrianidi C , Drakomathioulakis M , Groch L , Hlinomaz O , Rezek M , Semenka J , Sitar J , Beranova M , Kramarikova P , Pesl L , Sindelarova S , Tousek F , Warda H M , Ghaly I , Habiba S , Habib A , Gergis M N , Bahaa H , Samir A , Taha H Salah Eldin , Adel M , Algamal H Mahrous , Mamdouh M , Shaker A Foad , Shokry K , Konsoah A , Mostafa A Magdy , Ibrahim A , Imam A , Hafez B , Zahran A , Abdelhamid M , Mahmoud K , Mostafa A , Samir A , Abdrabou M , Kamal A , Sallam S , Ali A , Maghraby K , Atta A Radi , Saad A , Ali M , Lotman E-M , Lubi R , Kaljumäe H , Uuetoa T , Kiitam U , Durier C , Ressencourt O , El Din A Alaa , Guiatni A , Bras M Le , Mougenot E , Labeque J-N , Banos J-L , Capendeguy O , Mansourati J , Fofana A , Augagneur M , Bahon L , Pape A Le , Batias-Moreau L , Fluttaz A , Good F , Prieur F , Boiffard E , Derien A-S , Drapeau I , Roy N , Perret T , Dubreuil O , Ranc S , Rio S , Bonnet J-L , Bonnet G , Cuisset T , Deharo P , Mouret J-P , Spychaj J-C , Blondelon A , Delarche N , Decalf V , Guillard N , Hakme A , Roger M-P , Biron Y , Druelles P , Loubeyre C , Lucon A , Hery P , Nejjari M , Digne F , Huchet F , Neykova A , Tzvetkov B , Larrieu M , Quaino G , Armangau P , Sauguet A , Bonfils L , Dumonteil N , Fajadet J , Farah B , Honton B , Monteil B , Philippart R , Tchetche D , Cottin M , Petit F , Piquart A , Popovic B , Varlot J , Maisuradze D , Sagirashvili E , Kereselidze Z , Totladze L , Ginturi T , Lagvilava D , Hamm C , Liebetrau C , Haas M , Hamm C , Koerschgen T , Weferling M , Wolter J-S , Maier K , Nickenig G , Sedaghat A , Zachoval C , Lampropoulos K , Mpatsouli A , Sakellaropoulou A , Tyrovolas K , Zibounoumi N , Argyropoulos K , Toulgaridis F , Kolyviras A , Tzanis G , Tzifos V , Milkas A , Papaioannou S , Kyriazopoulos K , Pylarinou V , Kontonassakis I , Kotakos C , Kourgiannidis G , Ntoliou P , Parzakonis N , Pipertzi A , Sakalidis A , Ververeli C-L , Kafkala K , Sinanis T , Diakakis G , Grammatikopoulos K , Papoutsaki E , Patialiatos T , Mamaloukaki M , Papadaki S T , Kanellos I E , Antoniou A , Tsinopoulos G , Goudis C , Giannadaki M , Daios S , Petridou M , Skantzis P , Koukis P , Dimitriadis F , Savvidis M , Styliadis I , Sachpekidis V , Pilalidou A , Stamatiadis N , Fotoglidis A , Karakanas A , Ruzsa Z , Becker D , Nowotta F , Gudmundsdottir I , Libungan B , Skuladottir F Bjork , Halldorsdottir H , Shetty R , Iyengar S , Bs C , G S , Lakshmana S , S R , Tripathy N , Sinha A , Choudhary B , Kumar A , Kumar A , Raj R , Roy R Sagar , Dharma S , Siswanto B B , Farhan H Ali , Yaseen I F , Al-Zaidi M , Dakhil Z , Amen S , Rasool B , Rajeeb A , Amber K , Ali H Hameed , Al-Kinani T , Almyahi M Hashim , Al-Obaidi F , Masoumi G , Sadeghi M , Heshmat-Ghahdarijani K , Roohafza H , Sarrafzadegan N , Shafeie M , Teimouri-Jervekani Z , Noori F , Kyavar M , Sadeghipour P , Firouzi A , Alemzadeh-Ansari M J , Ghadrdoost B , Golpira R , Ghorbani A , Ahangari F , Salarifar M , Jenab Y , Biria A , Haghighi S , Mansouri P , Yadangi S , Kornowski R , Orvin K , Eisen A , Oginetz N , Vizel R , Kfir H , Pasquale G Di , Casella G , Cardelli L S , Filippini E , Zagnoni S , Donazzan L , Ermacora D , Indolfi C , Polimeni A , Curcio A , Mongiardo A , De Rosa S , Sorrentino S , Spaccarotella C , Landolina M , Marino M , Cacucci M , Vailati L , Bernabò P , Montisci R , Meloni L , Marchetti M F , Biddau M , Garau E , Barbato E , Morisco C , Strisciuglio T , Canciello G , Lorenzoni G , Casu G , Merella P , Novo G , D'Agostino A , Lisi D Di , Palermo A Di , Evola S , Immordino F , Rossetto L , Spica G , Pavan D , Mattia A Della , Belfiore R , Grandis U , Vendrametto F , Spagnolo C , Carniel L , Sonego E , Gaudio C , Barillà F , Biccire F G , Bruno N , Ferrari I , Paravati V , Torromeo C , Galasso G , Peluso A , Prota C , Radano I , Benvenga R M , Ferraioli D , Anselmi M , Frigo G M , Sinagra G , Merlo M , Perkan A , Ramani F , Altinier A , Fabris E , Rinaldi M , Usmiani T , Checco L , Frea S , Mussida M , Matsukawa R , Sugi K , Kitai T , Furukawa Y , Masumoto A , Miyoshi Y , Nishino S , Assembekov B , Amirov B , Chernokurova Y , Ibragimova F , Mirrakhimov E , Ibraimova A , Murataliev T , Radzhapova Z , Uulu E Sultan , Zhanyshbekova N , Zventsova V , Erglis A , Bondare L , Zaliunas R , Gustiene O , Dirsiene R , Marcinkeviciene J , Sakalyte G , Virbickiene A , Baksyte G , Bardauskiene L , Gelmaniene R , Salkauskaite A , Ziubryte G , Kupstyte-Kristapone N , Badariene J , Balciute S , Kapleriene L , Lizaitis M , Marinskiene J , Navickaite A , Pilkiene A , Ramanauskaite D , Serpytis R , Silinskiene D , Simbelyte T , Staigyte J , Philippe F , Degrell P , Camus E , Ahmad W A Wan , Kassim Z Abu , Xuereb R G , Buttigieg L-L , Camilleri W , Pllaha E , Xuereb S , Popovici M , Ivanov V , Plugaru A , Moscalu V , Popovici I , Abras M , Ciobanu L , Litvinenco N , Fuior S , Dumanschi C , Ivanov M , Danila T , Grib L , Filimon S , Cardaniuc L , Batrinac A , Tasnic M , Cozma C , Revenco V , Sorici G , Dagva M , Choijiljav G , Dandar E , Khurelbaatar M-U , Tsognemekh B , Appelman Y , Den Hartog A , Kolste H Jan Te , Van Den Buijs D , Van'T Hof A , Pustjens T , Houben V , Kasperski I , Ten Berg J , Azzahhafi J , Bor W , Yin D Chan Pin , Mbakwem A , Amadi C , Kushimo O , Kilasho M , Oronsaye E , Bakracheski N , Bashuroska E Kovacheska , Mojsovska V , Tupare S , Dejan M , Jovanoska J , Razmoski D , Marinoski T , Antovski A , Jovanovski Z , Kocho S , Markovski R , Ristovski V , Samir A B , Biserka S , Kalpak O , Peovska I Mitevska , Taleska B Zafirovska , Pejkov H , Busljetik O , Zimbakov Z , Grueva E , Bojovski I , Tutic M , Poposka L , Vavlukis M , Al-Riyami A , Nadar S K , Abdelmottaleb W , Ahmed S , Mujtaba M Shaikh , Al-Mashari S , Al-Riyami H , Laghari A H , Faheem O , Ahmed S Waqar , Qamar N , Furnaz S , Kazmi K , Saghir T , Aneel A , Asim A , Madiha F , Sobkowicz B , Tycinska A , Kazimierczyk E , Szyszkowska A , Mizia-Stec K , Wybraniec M , Bednarek A , Glowacki K , Prokopczuk J , Babinski W , Blachut A , Kosiak M , Kusinska A , Samborski S , Stachura J , Szastok H , Wester A , Bartoszewska D , Sosnowska-Pasiarska B , Krzysiek M , Legutko J , Nawrotek B , Kasprzak J D , Klosinska M , Wiklo K , Kurpesa M , Rechcinski T , Cieslik-Guerra U , Gierlotka M , Bugajski J , Feusette P , Sacha J , Przybylo P , Krzesinski P , Ryczek R , Karasek A , Kazmierczak-Dziuk A , Mielniczuk M , Betkier-Lipinska K , Roik M , Labyk A , Krakowian M , Machowski M , Paczynska M , Potepa M , Pruszczyk P , Budaj A , Ambroziak M , Omelanczuk-Wiech E , Torun A , Opolski G , Glowczynska R , Fojt A , Kowalik R , Huczek Z , Jedrzejczyk S , Roleder T , Brust K , Gasior M , Desperak P , Hawranek M , Farto-Abreu P , Santos M , Baptista S , Brizida L , Faria D , Loureiro J , Magno P , Monteiro C , Nédio M , Tavares J , Sousa C , Almeida I , Almeida S , Miranda H , Santos H , Santos A P , Goncalves L , Monteiro S , Baptista R , Ferreira C , Ferreira J , Goncalves F , Lourenço C , Monteiro P , Picarra B , Santos A R , Guerreiro R Azevedo , Carias M , Carrington M , Pais J , de Figueiredo M Paralta , Rocha A R , Mimoso J , De Jesus I , Fernandes R , Guedes J , Mota T , Mendes M , Ferreira J , Tralhão A , Aguiar C Tavares , Strong C , Da Gama F Fernandes , Pais G , Timóteo A T , Rosa S Aguiar Oliveira , Mano T , Reis J , Selas M , Mendes D Espregueira , Satendra M , Pinto P , Queirós C , Oliveira I , Reis L , Cruz I , Fernandes R , Torres S , Luz A , Campinas A , Costa R , Frias A , Oliveira M , Martins V , Castilho B , Coelho C , Moura A R , Cotrim N , Dos Santos R Carvalheira , Custodio P , Duarte R , Gomes R , Matias F , Mendonca C , Neiva J , Rabacal C , Almeida A Rocha , Caeiro D , Queiroz P , Silva G , Pop-Moldovan A L , Darabantiu D , Mercea S , Dan G-A , Dan A-R , Dobranici M , Popescu R A , Adam C , Sinescu C-J , Andrei C-L , Brezeanu R , Samoila N , Baluta M M , Pop D , Tomoaia R , Istratoaie O , Donoiu I , Cojocaru A , Oprita O C , Rocsoreanu A , Grecu M , Ailoaei S , Popescu M Ioachim , Cozma A , Babes E Emilia , Rus M , Ardelean A , Larisa R , Moisi M , Ban E , Buzle A , Filimon G , Dobreanu D , Lupu S , Mitre A , Rudzik R , Sus I , Opris D , Somkereki C , Mornos C , Petrescu L , Betiu A , Volcescu A , Ioan O , Luca C , Maximov D , Mosteoru S , Pascalau L , Roman C , Brie D , Crisan S , Erimescu C , Falnita L , Gaita D , Gheorghiu M , Levashov S , Redkina M , Novitskii N , Dementiev E , Baglikov A , Zateyshchikov D , Zubova E , Rogozhina A , Salikov A , Nikitin I , Reznik E V , Komissarova M S , Shebzukhova M , Shitaya K , Stolbova S , Larina V , Akhmatova F , Chuvarayan G , Arefyev M N , Averkov O V , Volkova A L , Sepkhanyan M S , Vecherko V I , Meray I , Babaeva L , Goreva L , Pisaryuk A , Potapov P , Teterina M , Ageev F , Silvestrova G , Fedulaev Y , Pinchuk T , Staroverov I , Kalimullin D , Sukhinina T , Zhukova N , Ryabov V , Kruchinkina E , Vorobeva D , Shevchenko I , Budyak V , Elistratova O , Fetisova E , Islamov R , Ponomareva E , Khalaf H , Shaimaa A Al , Kamal W , Alrahimi J , Elshiekh A , Balghith M , Ahmed A , Attia N , Jamiel A A , Potpara T , Marinkovic M , Mihajlovic M , Mujovic N , Kocijancic A , Mijatovic Z , Radovanovic M , Matic D , Milosevic A , Savic L , Subotic I , Uscumlic A , Zlatic N , Antonijevic J , Vesic O , Vucic R , Martinovic S Salinger , Kostic T , Atanaskovic V , Mitic V , Stanojevic D , Petrovic M , Kovacevic M , Crnomarkovic B , Cankovic M , Dabovic D , Jarakovic M , Pantic T , Trajkovic M , Pupic L , Ruzicic D , Cvetanovic D , Obradovic I , Stankovic M , Loh P H , Kong W , Poh K-K , Sia C-H , Saw K , Liška D , Brozmannová D , Gbur M , Maxian R , Kovacic D , Poznic N Glavnik , Keric T , Kotnik G , Cercek M , Steblovnik K , Sustersic M , Cercek A Cerne , Djokic I , Drnovsek B , Lipar L , Mocilnik M , Pleskovic A , Lainscak M , Crncic D , Nikojajevic I , Tibaut M , Cigut M , Leskovar B , Furlan T , Grilj V , Rezun M , Mateo V Martinez , Anguita M J Fernandez , Bustinza I C Möller , Quintana R Bangueses , Cimadevilla O C Fernandez , Fuertes J , Lopez F , Martin M D , Martinez L , Barrabes J A , Bañeras J , Belahnech Y , Ferreira-Gonzalez I , Jordan P , Lidon R-M , Mila L , Sambola A , Sionis A , Bragagnini W , Cambra A Duran , Simon C , Burdeus M Vidal , Ariza-Solé A , Alegre O , Alsina M , Ferrando J I Llao , Bosch X , Vidal P , Izquierdo M , Marin F , Esteve-Pastor M A , Tello-Montoliu A , Lopez-Garcia C , Rivera-Caravaca J M , Gil-Pérez P , Nicolas-Franco S , Keituqwa I , Silva L , Blasco A , Escudier J M , Ortega J , Zamorano J L , Sanmartin M , Pereda D Cordero , Rincon L M , Gonzalez P , Casado T , Lopez-Sendon J L , Manjavacas A M Iniesta , Marin L A Martinez , Sotelo L Rodriguez , Rodriguez S O Rosillo , Bueno H , Martin R , Maruri R , Moreno G , Moris C , Avanzas P , Ayesta A , Junco-Vicente A , Cubero-Gallego H , Pascual I , Sola N Basterra , Rodriguez O Alcalde , Malagon L , Martinez-Basterra J , Arizcuren A Munarriz , Romero J , Calleja A Gainza , Fuertes D García , Crespín Crespín M , Bernal F J Castillo , Ojeda F Bosa , Padron A Lara , Cabeza M Martin , Vargas C Mendez , Yanes G , Gonzalez M J Garcia , Gonzalez Gonzalez J , Jorge P , De La Fuente B , Bermúdez M Garcia , Perez-Lopez C M Bianchi , Basiero A Bonet , Ruiz A Carol , Pamias R Freixa , Chamero P Sanchez , Hidalgo-Urbano R , Garcia-Rubira J C , Seoane-Garcia T , Arroyo-Monino D F , Ruiz A Bardají , Sanz-Girgas E , Bonet G , Rodríguez-López J , Scardino C , De Sousa D , Elbasheer E , Humida A , Mahmoud H , Mohamed A , Hamid E , Hussein S , Abdelhameed M , Ali T , Ali Y , Eltayeb M , Ali M , Almubarak E , Badri M , Altaher S , Alla M Dafa , Dellborg M , Dellborg H , Hultsberg-Olsson G , Marjeh Y Bani , Abdin A , Alhussein F , Mgazeel F , Hammami R , Abid L , Bahloul A , Charfeddine S , Ellouze T , Canpolat U , Oksul M , Muderrisoglu H , Karacaglar E , Akgun A , Ari H , Ari S , Can V , Tuncay B , Kaya H , Dursun L , Kalenderoglu K , Tasar O , Kilic S , Kucukosmanoglu M , Aytekin V , Baydar O , Demirci Y , Gürsoy E , Kilic A , Yildiz Ö , Arat-Ozkan A , Sinan U Y , Gungor B , Sekerci S Sert , Zeren G , Erturk M , Demir A R , Yildirim C , Can C , Kayikcioglu M , Yagmur B , Oney S , Sabanoglu C , Inanc I H , Ziyrek M , Sen T , Astarcioglu M A , Kahraman F , Utku O , Celik A , Surmeli A O , Basaran O , Demirbag R , Besli F , Gungoren F , Ingabire P , Mondo C , Ssemanda S , Semu T , Al Mulla A , Atos J S , Wajid I , Al Mahmeed W A R , Atallah B , Bakr K , Garrod R , Makia F , Eldeeb F , Abdekader R , Gomaa A , Kandasamy S , Maruthanayagam R , Nakad G , Nair R , Mota P , Prior P , Mcdonald S , Rand J , Schumacher N , Abraheem A , Clark M , Coulding M , Turner V , Negahban A Q , Crew A , Hope S , Howson J , Jones S , Lancaster N , Nicholson A , Wray G , Donnelly P , Hammond L , Hammond S , Regan S , Watkin R , Papadopoulos C , Ludman P , Hutton K , Macdonald S , Nilsson A , Roberts S , Garg S , Balachandran K , Mcdonald J , Singh R , Marsden K , Davies K , Desai H , Goddard W , Iqbal N , Chalil S , Galasko G , Assaf O , Benham L , Brown J , Collins S , Fleming C , Glen J , Mitchell M , Preston S , Uttley A , Lindsay S , Akhtar N , Atkinson C , Vinod M , Wilson A , Clifford P , Firoozan S , Yashoman M , Bowers N , Chaplin J , Harvey S , Kononen M , Lopesdesousa G , Saraiva F , Sharma S , Cruddas E , Law J , Young E , Hoye A , Harper P , Rowe K , Been M , Cummins H , French E , Gibson C , Abraham J A , Hobson S , Kay A , Kent M , Wilkinson A , Clark S , Duncan L , Ahmed I M , Khatiwada D , Mccarrick A , Wanda I , Read P , Afsar A , Rivers V , Theobald T , Bell S , Buckman C , Francis R , Peters G , Stables R , Morgan M , Noorzadeh M , Taylor B , Twiss S , Widdows P , Wilkinson V , Black M , Clark A , Clarkson N , Currie J , George L , Mcgee C , Izzat L , Lewis T , Omar Z , Phillips S , Ahmed F , Mackie S , Oommen A , Phillips H , Sherwood M , Aleti S , Charles T , Jose M , Kolakaluri L , Al Karoudi R , Deery J , Hazelton T , Knight A , Price C , Turney S , Kardos A , Williams F , Wren L , Bega G , Scaletta D , Kunadian V , Cullen K , Jones S , Kirkup E , Ripley D P , Matthews I G , Mcleod A , Runnett C , Thomas H E , Gunarathne A , Burton J , King R , Quinn J , Sobolewska J , Munt S , Porter J , Christenssen V , Leng K , Peachey T , Temple N , Wells K , Viswanathan G , Taneja A , Cann E , Eglinton C , Hyams B , Jones E , Reed F , Smith J , Affleck D-C , Turner A , Ward T , Wilmshurst N , Stirrup J , Brunton M , Whyte A , Smith S , Murray V , Walker R , Weston C , Brown C , Collier D , Curtis K , Dixon K , Wells T , Trim F , Ghosh J , Mavuri M , Barman L , Elliott K , Harrison R , Mallinson J , Neale T , Smith J , Toohie J , Turnbull A , Parker E , Hossain R , Cheeseman M , Hill J , Hood M , Hutchinson D , Mellows K , Pendlebury C , Storey R F , Barker J , Birchall K , Denney H , Housley K , Middle J , Kukreja N , Gati S , Kirk P , Lynch M , Srinivasan M , Szygula J , Baker P , Cruz C , Derigay J , Lamb K , Nembhard S , Price A , Mamas M , Massey I , Wain J , Delaney J , Junejo S , Martin K , Obaid D , Brinkworth E , Davies C , Evans D , Richards S , Thomas C , Williams M , Dayer M , Mills H , Roberts K , Goodchild F , Greig N , Kundu S , Donaldson D , Tonks L , Beekes M , Button H , Hurford F , Motherwell N , Summers-Wall J , Felmeden D , Keeling P , Sheikh U , Yonis A , Felmeden L , Hughes D , Micklewright L , Summerhayes A , Sutton J , Panoulas V , Prendergast C , Rogers P , Barker L N , Batin P , Conway D , Exley D , Fletcher A , Wright J , Nageh T , Hadebe B , Kunhunny S , Mshengu E , Karthikeyan V J , Hamdan H , Cooper J , Dandy C , Parkinson V , Paterson P , Reddington S , Taylor T , Tierney C , Jones K Vandesnepscheut , Broadley A , Beesley K , Buckley C , Hellyer C , Pippard L , Pitt-Kerby T , Azam J , Hayes C , Freshwater K , Johnson L , Mcgill Y , Redfearn H , Russell M , Alyavi A , Alyavi B , Uzokov J 
Published: February 2023

Background

The majority of NSTEMI burden resides outside high-income countries (HICs). We describe presentation, care, and outcomes of NSTEMI by country income classification.

Methods and results

Prospective cohort study including 2947 patients with NSTEMI from 287 centres in 59 countries, stratified by World Bank country income classification. Quality of care was evaluated based on 12 guideline-recommended care interventions. The all-or-none scoring composite performance measure was used to define receipt of optimal care. Outcomes included in-hospital acute heart failure, stroke/transient ischaemic attack, and death, and 30-day mortality. Patients admitted with NSTEMI in low to lower-middle-income countries (LLMICs), compared with patients in HICs, were younger, more commonly diabetic, and current smokers, but with a lower burden of other comorbidities, and 76.7% met very high risk criteria for an immediate invasive strategy. Invasive coronary angiography use increased with ascending income classification (LLMICs, 79.2%; upper middle income countries [UMICs], 83.7%; HICs, 91.0%), but overall care quality did not (≥80% of eligible interventions achieved: LLMICS, 64.8%; UMICs 69.6%; HICs 55.1%). Rates of acute heart failure (LLMICS, 21.3%; UMICs, 12.1%; HICs, 6.8%; P &lt; 0.001), stroke/transient ischaemic attack (LLMICS: 2.5%; UMICs: 1.5%; HICs: 0.9%; P = 0.04), in-hospital mortality (LLMICS, 3.6%; UMICs: 2.8%; HICs: 1.0%; P &lt; 0.001) and 30-day mortality (LLMICs, 4.9%; UMICs, 3.9%; HICs, 1.5%; P &lt; 0.001) exhibited an inverse economic gradient.

Conclusion

Patients with NSTEMI in LLMICs present with fewer comorbidities but a more advanced stage of acute disease, and have worse outcomes compared with HICs. A cardiovascular health narrative is needed to address this inequity across economic boundaries.