Key result
New local PCI access linked to ~2 percentage point lower 30-day post-AMI mortality.
Why the study?
The impact of expanding PCI-capable facilities on clinical outcomes in communities with and without prior PCI access was unclear.
Does the opening of new PCI-capable facilities improve mortality and access to care for AMI patients in communities without baseline PCI access compared to those with baseline access?
Cohort (n=590,282)
Yes
Does the opening of new PCI-capable facilities improve mortality and access to care for AMI patients in communities without baseline PCI access compared to those with baseline access?
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Americans tend to think more is better, but where you put these services really matters. Think of gas stations, for example. Adding another one in a neighborhood that already has five might make things a little more convenient. But if you put a gas station in an area where people previously had to drive 30 miles to find one, you're meeting a real need. With emergency care, filling that gap can save lives.”
“When we invest millions of dollars in specialized health care infrastructure, the question shouldn't just be whether we can provide more services. We should be asking where those services will do the most good. We want to expand access, but we need to expand it wisely.”
Expanding percutaneous coronary intervention (PCI) facilities significantly reduces mortality and improves access in previously underserved areas, but provides no mortality benefit and inefficient duplication of services in already served communities.
Importance The proliferation of percutaneous coronary intervention (PCI) facilities across the US has raised questions about whether expanding capacity improves outcomes in areas already served vs those without prior access. Objective To evaluate the association between the opening of PCI-capable facilities and outcomes following acute myocardial infarction (AMI) in communities with and without baseline PCI access. Design, Setting, and Participants This cohort study used California data from inpatient, emergency department, and ambulatory surgery encounters from January 1, 2011, to December 31, 2022, including all adults hospitalized with a primary diagnosis of AMI. Zip code communities were categorized by baseline (2011) access to PCI-capable facilities within a 30-minute drive. Exposure Opening of a PCI-capable facility within 30 minutes of a community’s zip code during the study period. Main Outcomes and Measures Primary outcomes were (1) admission to a PCI-capable facility, (2) receipt of PCI during the index hospitalization, (3) unscheduled acute care visit within 30 days, and (4) all-cause mortality at 30 days and 1 year. Linear probability models with community and time-fixed effects estimated changes in outcomes following PCI facility openings separately for communities with and without baseline access. Results Among 590 282 patients with AMI (157 435 younger than age 60 years [27%]; 222 773 female [38%]; 63 460 Asian [11%], 129 137 Hispanic [22%], 315 326 White [53%]), 500 778 (85%) lived in communities with baseline PCI access, and 89 504 (15%) lived in communities without; 18 805 patients (21%) without baseline access experienced a PCI opening. Openings in communities without baseline access were associated with a 30.0 percentage point (pp) increase (95% CI, 28.2 to 31.8 pp) in admission to PCI-capable hospitals and a 5.1 pp increase (95% CI, 3.3 to 7.0 pp) in PCI receipt, along with reductions in 30-day (–1.8 pp; 95% CI, –3.2 to –0.5 pp) and 1-year (–2.8 pp; 95% CI, –4.7 to –1.0 pp) mortality. In contrast, openings in communities with baseline access were associated with smaller gains in admission (1.5 pp; 95% CI, 1.1 to 1.9 pp), modest increases in PCI use (1.0 pp; 95% CI, 0.5 to 1.6 pp), decreases in unscheduled visits within 30 days (–0.7 pp; 95% CI, –1.2 to –0.2 pp), and no mortality change. Sensitivity analyses restricted to higher-volume PCI centers (50 annual cases or more) yielded consistent findings. Conclusions and Relevance In this cohort study of 590 282 patients with AMI in California, opening new PCI facilities was associated with substantial improvements in communities without prior PCI availability, including a 53% relative increase in access to admission, 16% increase in PCI use, and 20% and 15% reductions in 30-day and 1-year mortality, respectively. In contrast, already served areas showed smaller benefits and no mortality improvement. PCI expansion should prioritize underserved regions to maximize population-level benefits and avoid inefficient duplication of services.
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Yu-Chu et al. (2026) conducted a cohort in Acute Myocardial Infarction (n=590,282). Opening of a PCI-capable facility within a 30-minute drive vs. Communities without new PCI facility openings was evaluated on 30-day mortality in communities without baseline access (-1.8 pp, 95% CI -3.2 to -0.5). Opening new PCI facilities in communities without prior access was associated with a 1.8 percentage point reduction (95% CI, -3.2 to -0.5) in 30-day mortality for patients with acute myocardial infarction.
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