Rural patients with non–ST-segment elevation myocardial infarction (NSTEMI) often present to local hospitals that lack cardiac revascularization capability, necessitating transfer to referral centers (RCs) to receive guideline-recommended care. After national guidelines were updated in 2002 to promote routine early coronary angiography and revascularization for NSTEMI, access to specialized care for rural populations became increasingly important. This study evaluates changes before and after guideline implementation in the proportion of rural patients receiving care at referral centers and undergoing cardiac procedures, with particular attention to the impact of geographic distance on access to care.
