Benefits of PCI facility openings vary depending on baseline access
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Key takeaways:
- PCI center openings within a short drive in average-capacity markets were tied to significant benefits in access and outcomes for people with acute MI.
- These effects were not seen in high-capacity PCI markets.
In average-capacity markets, patients with acute MI were more likely to receive revascularization on the day of admission or during an in-hospital care episode and were less likely to die as more PCI centers opened, data show.
In an analysis of PCI hospital availability within a 15-minute driving time of ZIP code communities, researchers did not observe these same benefits for patients with acute MI in high-capacity markets, suggesting a threshold for benefit.
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“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 acute myocardial infarction, 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,” Renee Y. Hsia, MD, MSc, professor in the department of emergency medicine at University of California, San Francisco, and colleagues wrote in JACC: Cardiovascular Interventions. “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.”
More centers improved care for some
In a retrospective study, Hsia and colleagues assessed PCI hospital availability within a 15-minute driving time of ZIP code communities, stratifying communities by baseline PCI capacity. The study included 2,742,530 patients from 2006 to 2017.
“By study design, about one-quarter of patients lived in a high-capacity market, while the remaining three-quarters lived in an average-capacity market,” the researchers wrote.
Researchers then identified changes in outcomes associated with PCI-providing hospital openings and closures.
From 2006 to 2017, 20% of patients in average-capacity markets and 16% of patients in high-capacity markets experienced a PCI hospital opening within a 15-minute drive.
In average-capacity markets, openings were associated with a 2.6-percentage-point decrease in admission to a high-volume PCI facility; whereas high-capacity markets saw an 11.6-percentage-point decrease.
“Given that at baseline, 58.6% of acute MI patients were admitted to high-volume PCI hospitals, the 11.6 percentage point decrease represents a 20% drop in the likelihood of receiving revascularization in a high-volume PCI center in high-capacity markets,” the researchers wrote.
After a PCI center opening, patients in average-capacity markets experienced a 5.5% and 7.6% relative increase in likelihood of same-day and in-hospital revascularization, respectively, as well as a 2.5% decrease in mortality. There was no change observed in high-capacity PCI markets.
PCI hospital closures in average-capacity markets were associated with a 10.4% relative increase from baseline in admission to high-volume PCI hospitals and a 1.4-percentage-point decrease in receipt of same-day PCI, according to the researchers.
“After openings, patients in average-capacity markets derived significant benefits, whereas those in high-capacity markets did not,” the researchers wrote. “This suggests that past a certain threshold, facility opening does not improve access and health outcomes.”
Assessing quality care
In a related editorial, Steven R. Bailey, MD, FACC, MSCAI, FAHA, chief of cardiology at the University of Texas Health Sciences Center, wrote that beyond improving access to care, research should assess whether the opening of new PCI facilities improves access to quality care.
“This paper found similar 30-day and 1-year mortality in high-volume and average-volume hospitals, suggesting that there may be similar outcomes from this analysis,” the researchers wrote. “We need current data addressing how we provide best practices for all patients, especially addressing the social determinants of health.”
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