Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 17 2 2022 04 30 56 61 Seyed Hesameddin Abbasi Tehran University of Medical Sciences, Tehran, Iran. Örjan Sundin Department of Psychology, Mid-Sweden University, Östersund, Sweden. Arash Jalali Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Joaquim Soares Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden. Gloria Macassa Department of Health Sciences, Section of Public Health Sciences, Mid Sweden University, Sundsvall, Sweden. 2022 05 15 2022 06 18 Background: Current evidence shows inequality in the outcomes of rural and urban patients treated at their place of residence. This study compared in-hospital mortality between rural and urban patients with acute coronary syndrome (ACS) to find whether there were differences in the outcome and received treatment. Methods: Between May 2007 and January 2018, patients admitted with ACS were included. The patients’ demographic, clinical, and laboratory data, as well as their in-hospital medical courses, were recorded. The association between place of residence (rural/urban) and in-hospital mortality due to ACS was evaluated using logistic regression adjusted for potential confounders. Results: Of 9088 recruited patients (mean age =61.30±12.25 y; 5557 men [61.1%]), 838 were rural residents. A positive family history of coronary artery disease (P=0.003), smoking (P=0.002), and hyperlipidemia (P=0.026), as well as a higher body mass index (P=0.013), was seen more frequently in the urban patients, while the rural patients had lower education levels (P<0.001) and higher unemployment rates (P=0.009). In-hospital mortality occurred in 135 patients (1.5%): 10 rural (1.2%) and 125 urban (1.5%) patients (P=0.465). The Firth regression model, used to adjust the effects of possible confounders, showed no significant difference concerning in-hospital mortality between the rural and urban patients (OR, 1.57; 95% CI, 0.376 to 7.450; P=0.585). Conclusion: This study found no significant differences in receiving proper treatment and in-hospital mortality between rural and urban patients with ACS. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1653 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1653/1006