Acute myocardial infarction patients in rural areas were less likely to be transported directly to PCI-capable facilities, resulting in a significantly lower prevalence of timely primary percutaneous coronary intervention (11.5% vs. 20.7%) compared to metropolitan patients.
Observational (n=3,388)
Yes
Does rural versus metropolitan location impact the rate of direct ambulance transport and onset-to-balloon time in patients with acute myocardial infarction undergoing primary PCI?
AMI patients in rural areas of Japan experience significant delays in onset-to-balloon time compared to metropolitan patients, primarily driven by lower rates of direct ambulance transport to PCI-capable facilities.
Absolute Event Rate: 11.5% vs 20.7%
p-value: p=<0.01
BACKGROUND: There are few reports examining regional differences between rural prefectures and metropolitan areas in the management of acute myocardial infarction (AMI) in Japan. METHODS AND RESULTS: In the Rural AMI registry, a prospective, multi-prefectural registry of AMI in 4 rural prefectures (Ishikawa, Aomori, Ehime and Mie), a total of 1,695 consecutive AMI patients were registered in 2013. Among them, 1,313 patients who underwent primary percutaneous coronary intervention (PPCI) within 24 h of onset were enrolled in this study (Rural group), and compared with the cohort data from the Tokyo CCU Network registry for AMI in the same period (Metropolitan group, 2,075 patients). The prevalence of direct ambulance transport to PCI-capable facilities in the Rural group was significantly lower than that in the Metropolitan group (43.8% vs. 60.3%, P<0.01), which resulted in a longer onset-to-balloon time (OTB: 225 vs. 210 min, P=0.02) and lower prevalence of PPCI in a timely fashion (OTB ≤2 h: 11.5% vs. 20.7%, P<0.01) in the Rural group. Multivariate analysis revealed that direct ambulance transport was the strongest predictor for PPCI in a timely fashion (odds ratio=4.13, P<0.001). CONCLUSIONS: AMI patients in rural areas were less likely to be transported directly to PCI-capable facilities, resulting in time delay to PPCI compared with those in metropolitan areas.
Masuda et al. (Mon,) conducted a observational in Acute myocardial infarction (AMI) (n=3,388). Rural area residence vs. Metropolitan area residence was evaluated on Onset-to-balloon time ≤2 hours (p=<0.01). Acute myocardial infarction patients in rural areas were less likely to be transported directly to PCI-capable facilities, resulting in a significantly lower prevalence of timely primary percutaneous coronary intervention (11.5% vs. 20.7%) compared to metropolitan patients.