Key result
Lower population density is linked to ~9% higher in-hospital AMI mortality at low-volume PCI hospitals.
Why the study?
Low population density may be associated with high mortality in AMI patients, but the combined effect of population density and hospital primary PCI volume on in-hospital mortality required investigation in Japan.
Does low population density and transport to low-volume primary PCI hospitals increase in-hospital mortality in patients with acute myocardial infarction?
Cohort (n=64,414)
Yes
Does low population density and transport to low-volume primary PCI hospitals increase in-hospital mortality in patients with acute myocardial infarction?
Effect estimate: OR 1.086 (95% CI 1.042-1.132)
p-value: p=<0.001
Increased in-hospital mortality related to low population density in AMI patients is driven by transport to low-volume primary PCI hospitals, suggesting patients should be triaged directly to high-volume centers regardless of distance.
May indicate higher AMI mortality in low-density areas via low-volume hospitals; leaves open whether volume-based triage improves outcomes.
BACKGROUND: Low population density may be associated with high mortality in acute myocardial infarction (AMI) patients. The purpose of this study was to investigate the effect of population density and hospital primary percutaneous coronary intervention (PCI) volume on AMI in-hospital mortality in Japan. METHODS AND RESULTS: . There was a significant negative relationship between population density and in-hospital mortality (OR for a quartile down in population density 1.086, 95% CI 1.042-1.132, P<0.001). Patients in less densely populated areas were more often transported to hospitals with a lower primary PCI volume, and they had a longer distance to travel. By using multivariable analysis, primary PCI volume was found to be significantly associated with in-hospital mortality, but distance to hospital was not. When divided into the low- and high-volume hospitals, using the cut-off value of 115 annual primary PCI procedures, the increase in in-hospital mortality associated with low population density was observed only in patients hospitalized in the low-volume hospitals. CONCLUSIONS: Increased in-hospital mortality related to low population density was observed only in AMI patients who were transported to the low primary PCI volume hospitals, but not in those who were transported to high-volume hospitals.
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Matsuzawa et al. (2020) conducted a cohort in Acute Myocardial Infarction (AMI) (n=64,414). Low population density vs. High population density was evaluated on In-hospital mortality (OR 1.086, 95% CI 1.042-1.132, p=<0.001). A decrease of one quartile in population density was associated with an 8.6% higher risk of in-hospital mortality (OR 1.086) among AMI patients, an effect observed only in low-volume PCI hospitals.
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