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Background In a universal healthcare system, the expectation is that all patients receive equitable, high-quality care, regardless of socioeconomic status (SES). While previous studies suggest that standardised healthcare frameworks mitigate disparities in ST-segment elevation myocardial infarction (STEMI) outcomes, the impact on non-ST elevation myocardial infarction (NSTEMI) treatment remains uncertain. This study evaluates whether universal healthcare ensures optimal percutaneous coronary intervention (PCI) outcomes across different SES groups and highlights potential disparities in NSTEMI care.Methods We conducted a retrospective cohort analysis of 437,024 patients from the British Cardiovascular Intervention Society (BCIS) database (2007–2014), stratifying outcomes by quintiles of the Index of Multiple Deprivation (IMD). The primary endpoint was 30-day all-cause mortality, with secondary analyses at 1-year and 5-year follow-ups. Hazard ratios (HRs) were derived using Cox regression models adjusted for clinical and procedural variables, accounting for hospital clustering effects. Multiple imputation methods were applied to address missing data, ensuring robust estimates. Variables included in the model encompassed patient demographics, cardiovascular risk factors, procedural details, and post-procedural complications. To validate the findings, sensitivity analyses were performed, assessing different modelling approaches and ensuring consistency across subgroups.Results Among patients undergoing PCI, 39.9% had stable coronary artery disease (CAD), 38.4% had NSTEMI, and 21.6% had STEMI. Overall, crude mortality rates increased with worsening deprivation (from 26.7 to 28.5 per 1,000 person-years; p < 0.0001). However, SES-driven disparities were primarily observed in NSTEMI patients, with those from the most deprived quintile (Q5) exhibiting significantly higher adjusted 30-day mortality rates (HR: 1.14; 95% CI: 1.06–1.24; p < 0.0001) compared to the least deprived quintile (Q1). These disparities persisted at 1-year (HR: 1.09; 95% CI: 1.04–1.14) and 5-year follow-ups (HR: 1.10; 95% CI: 1.06–1.16). In contrast, no significant socioeconomic disparities were observed in STEMI or stable CAD outcomes after adjustment for clinical confounders.Conclusions While STEMI management appears equitable, NSTEMI outcomes show a persistent socioeconomic gap. Deprived patients face higher mortality despite PCI access, likely due to structural, behavioural, and systemic barriers affecting timely care. Delayed presentation, lower healthcare engagement, and underuse of aggressive intervention may contribute. A key limitation of this study is using an area-based SES measure, which may not fully capture individual disparities. Addressing these inequities requires targeted public health interventions, better risk stratification, and optimised care pathways to ensure true equity in cardiovascular outcomes.