Introduction: The current prehospital and Emergency Department (ED) management of non-ST elevation acute coronary syndrome (NSTE-ACS) patients in Romania is poorly described.

Methods: We analysed the patient profiles, prehospital and ED management of 1185 NSTE-ACS patients diagnosed by troponin I assays with unstable angina (UA) or non-ST elevation myocardial infarction (NSTEMI) consecutively enrolled between 2016 and 2019 in 9 invasive hospitals.

Results: 387 UA and 798 NSTEMI patients were included. Mean age (63 years for UA, 64 years for NSTEMI) and gender were similar between groups. NSTEMI patients were more often from an urban area (OR 1.43, p< 0.01), transported by ambulance (OR 4.19, p< 0.001) and transferred from other hospitals (OR 5.76, p< 0.001). Established cardiovascular disease (CVD), known risk factors, heart failure and chronic CVD treatment were more frequent in the UA group. Symptom onset to ED time was similar for UA and NSTEMI in the self-presented to the ED patients group (280 vs. 240 minutes, p 0.251). In the direct transport by ambulance to the invasive hospitals, no difference between the UA and NSTEMI patients was found regarding the symptom onset to ambulance arrival time (median 177 vs. 176 minutes, p 0.495), ambulance arrival to ED time (median 50 vs. 56 minutes, p 0.465) or symptom onset to ED time (247 vs. 270 minutes, p 0.120). In the transferred patients group, UA and NSTEMI patients had similar symptom onset to ambulance times (median 250 minutes for both groups, p 0.773), ambulance arrival to ED time (median 196 vs. 150 minutes, p 0.189) and symptom onset to ED time (637.5 vs. 525 minutes, p 0.575). No significant differences were observed in the ED to Cardiology Department admission time (median 76 vs. 90 minutes, p 0.160).

Conclusions: The profiles of UA and NSTEMI patients in Romania significantly differ, in regard to risk factors, established CVD and chronic treatment. Although NSTEMI patients required a more intensive intervention, prehospital and ED time management was comparable to UA patients. In the absence of an established national NSTE-ACS network, tertiary care hospitals serve as regional centres for invasive management. NSTEMI is recognized as a higher risk condition compared to UA, reflected by the significantly higher rate of patient transfers from non-invasive to invasive centres. The authors were supported by the Romanian Academy of Medical Sciences and European Regional Development Fund: Funding Contract 2/Axa 1/31.07.2017/ SMIS 107124.