Acute chest pain—are outcomes influenced by the pattern of care—city versus county hospitals?

The management of acute coronary syndromes (ACS) continues to attract considerable scrutiny. Within a few months of their publication, the American Guidelines on the management of ACS without ST elevation have been revised to include data from further randomized trials including Clopidogrel in Unstable angina to prevent Recurrent ischemic Events (CURE) and Treat angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy—Thrombolysis In Myocardial Infarction-18 (TACTICS-TIMI 18) [1, 2 and 3]. Revisions to the recent European guidelines [4] are to follow. Further information about practice patterns and outcomes will come from international ACS registries such as the Global Registry of Acute Coronary Events (GRACE), EuroHeart-ACS and national registries such as the Prospective Registry of Acute Ischemic Syndromes in the UK (PRAIS-UK) [5, 6 and 7]. One of the many questions being addressed by these data is: are outcomes influenced by the pattern of care?