In-Hospital Outcomes According to Treatment Strategy in NSTEMI Patients Undergoing Coronary Angiography: No Index Revascularization, PCI, or CABG?

Background/Objectives: Real-world data comparing treatment strategies and in-hospital outcomes across no index revascularization, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) in NSTEMI patients remain limited. Methods: In this single-center retrospective cohort study, 1906 NSTEMI patients undergoing coronary angiography were categorized into no index revascularization (n = 946), PCI (n = 709), or CABG (n = 251) groups. The primary endpoint was in-hospital major adverse cardiovascular events (MACE), defined as all-cause mortality, cardiac arrest requiring cardiopulmonary resuscitation, sustained ventricular tachycardia/ventricular fibrillation, dialysis-requiring acute kidney injury, or stroke. Missing data were handled using multiple imputation with chained equations (MICE), and propensity score-based inverse probability of treatment weighting (IPTW) was used as a sensitivity analysis. Results: In-hospital MACE was higher in the no index revascularization group than in the PCI and CABG groups (9.8% vs. 3.5% vs. 4.8%; p < 0.001). Patients managed with no index revascularization were older and had a greater comorbidity burden, lower left ventricular ejection fraction, and more frequent Killip class ≥ 2. In the primary multivariable model, chronic kidney disease, Killip class ≥ 2, lower LVEF, CRP, and male sex were associated with in-hospital MACE, whereas neither PCI nor CABG strategy was independently associated with MACE. IPTW sensitivity analyses yielded similar directions of association; however, the PCI estimate crossed the conventional significance threshold after 1st–99th percentile weight truncation. Conclusions: Patients managed with no index revascularization had a higher baseline risk profile and higher unadjusted in-hospital MACE and mortality. The observed between-group differences should be interpreted as associations rather than causal effects of treatment strategy because of substantial confounding by indication.