How improving access to PCI affects heart attack outcomes
Improving access to percutaneous coronary intervention (PCI) is directly associated with better outcomes for acute myocardial infarction (AMI) patients in a majority of U.S. markets, according to new data published in JACC: Cardiovascular Interventions.[1] The one exception to this rule is markets where PCI is already readily available.
“To date, no studies have evaluated the proliferation of PCI centers to determine how PCI center openings (and conversely, closures) have affected outcomes for patients with AMI, nor has the literature established whether there have been differential effects for patients in communities that already had high PCI capacity at baseline compared with those in average-capacity PCI markets,” wrote first author Yu-Chu Shen, PhD, a professor of economics with the Naval Postgraduate School in California, and colleagues. “This research is necessary because the introduction of additional PCI services in high-capacity PCI markets could reduce per-hospital PCI volume, which has been associated with poorer outcomes.”
Shen et al. examined Medicare data to track AMI patients, American Hospital Association and Healthcare Cost Report Information System data to track hospital characteristics and U.S. Census Bureau data to determine the demographics of ZIP codes throughout the United States.
The team’s analysis focused on data from more than 2.7 million patients treated from 2006 to 2017. While roughly one in four patients lived in a high-capacity market—saturated markets, in other words—all other patients were categorized as living in an average-capacity market. The study’s key variable was the opening or closure of a PCI-capable facility within a 15-minute drive from the center of any given ZIP code.
“We chose a threshold of 15 minutes driving time to the opened or closed facility based on thresholds reported in other studies and prior literature showing that the majority of hospital visits are within 15 minutes of a patient’s residence,” the authors wrote. “This decision was further supported by clinical data showing that, after 90 minutes, every 15-minute delay in receipt of care for ST-elevation myocardial infarction (STEMI) patients is associated with a significant increase in the risk of death.”
Overall, the opening of new facilities where AMI patients could seek cardiovascular care was associated with “significant benefits” in average-capacity markets. These benefits include a reduced chance of being admitted to a high-volume facility where it may be hard to be seen in an acceptable timeframe, an increased likelihood of same-day and in-hospital revascularization and—perhaps most importantly—a 2.5% decrease in AMI mortality.
These statistics suggest that care improves for a majority of patients when new PCI centers are opened in the surrounding area. On a similar note, closing a PCI-capable hospital is associated with an increased chance of being admitted to a high-volume center and a decreased likelihood of being treated with same-day PCI.
In high-capacity markets, the team noted, opening or closing a new facility was not linked to any significant changes.
“Our findings have implications for the quality of AMI care, providing support for the idea that harmful consequences may result from the preferential adoption of PCI in markets where such services are already saturated,” the authors wrote. “AMI has well-defined treatment guidelines, and we would not expect the opening of a PCI center to increase or decrease the need for PCI among AMI patients in a community. The relatively fixed community-level PCI demand implies that opening a PCI center in a high-capacity market results in lower per-facility volumes, as confirmed in our findings.”
Also, they added, further research on how the opening of PCI-capable facilities can impact patient care is “crucial.”
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Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.