Clinical practice patterns for percutaneous coronary intervention (PCI) may vary across healthcare systems, but whether these differences translate into variation in procedural strategies and outcomes remains uncertain. In a retrospective observational analysis published in the American Journal of Therapeutics, PCI strategies were evaluated in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) across two university hospitals in Romania and Germany. 

The analysis included 392 consecutive high- and very high-risk patients who underwent PCI in 2022 (Romania n=221; Germany n=171). Patients in Romania were younger (64.3 vs. 71.8 years; P<0.001) but had a higher burden of cardiovascular risk factors, including dyslipidemia, diabetes, prior ACS, and left ventricular ejection fraction (LVEF) ≤40% (all P<0.05). Pretreatment with P2Y12 inhibitors was more frequent in Romania (78.3% vs. 1.3%; P<0.001). Despite these differences, coronary artery disease complexity remained similar, with comparable SYNTAX scores, left main disease, and multivessel involvement.

Procedural characteristics were largely consistent across centers, including radial access, ad hoc culprit-lesion PCI, and complete anatomical revascularization. Adjunctive PCI techniques, including intravascular imaging, were more frequently used in Germany (29.8%). In-hospital major adverse cardiac and cerebrovascular events (MACCE) were comparable between groups (10.4% vs. 7.6%; P>0.05) and were associated with lower LVEF (P<0.001).

These findings indicate that PCI strategies and short-term outcomes remained similar across centers despite differences in baseline risk profiles, with lower LVEF consistently associated with adverse events.