OBJECTIVES: Randomized clinical trials comparing percutaneous coronary interventions (PCI) and non-invasive treatment of acute coronary syndromes mostly favour the invasive approach. This study aimed at assessing whether in a real life setting PCI has an impact on outcomes as hospitalization cost, length of stay (LOS) and mortality in patients hospitalized for acute coronary syndromes (ACS) in Belgium. METHODS: The hospitalization cost, average length of stay (LOS) and mortality among hospitalized patients with ACS were estimated using the longitudinal IMS Hospital Disease Database (year 2013), including data on about 24% of Belgian hospital beds. Stays were identified based on ICD-9 coding and split in ST-elevated Myocardial infarction (STEMI ICD-9: 410 excluding 410.7), non-STEMI (NSTEMI: ICD-9: 410.7-411.89) and unstable angina (UA; ICD-9: 411.1-411.8-413.0). PCIs were identified with ICD-9 code 36.0. Comparisons were performed using a Wilcoxon non-parametrical test for cost/ LOS and a Chi-square for mortality. RESULTS: