Timely PCI Access Not Improved by Increase in PCI-Capable Hospitals

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Despite a large increase in the number of hospitals in the United States providing percutaneous coronary intervention (PCI) over a 5-year period, the proportion of the population with timely access—required for effective treatment of ST-segment elevation myocardial infarction (STEMI)—barely changed, according to research published online December 6, 2011, ahead of print in Circulation: Cardiovascular Quality and Outcomes.

For the study, Thomas W. Concannon, PhD, of Tufts Medical Center (Boston, MA), and colleagues examined data on the PCI capability of US hospitals and the percentage of the adult population living within a 60-minute drive of one of these centers. They then compared the results with those of a similar 2001 study.

Little Return on Investment

Analysis showed that over the 5-year period there was a 44% relative increase in the number of PCI hospitals nationwide. Compared with only 25% of all hospitals in 2001, by 2006 36.3% of hospitals offered PCI. However, during that time, there was only a 1% increase in the proportion of the population with access to the procedure within 60 minutes. Minimal improvement was seen in median drive time to a PCI-capable hospital or median time from a 911 call to hospital arrival (table 1).

Table 1. Changes in Availability and Accessibility of PCI-Capable Hospitals: 2001 vs. 2006

 

2001

2006

Number of PCI-Capable Hospitals

1,176

1,695

Population with 60-Minute Drive to PCI

79.0%

79.9%

Median Drive Time to PCI-Capable Hospital, min

11.3

10.5

Median Time from 911 Call to Hospital Arrival, min

25.6

25.1


Noticeable regional variation in PCI access persisted in 2006, with 7 states having 60-minute access rates of 90% or greater and 7 states having rates of 50% or lower. However, between 2001 and 2006 the percentage of the population living closest to a PCI-capable hospital improved from 42% to 51%, potentially reducing driving time for primary PCI for at least 9% of the population.

According to the authors, more information is needed on the relationship between changes in PCI capability over time and service utilization, expenditures, patient outcomes, and population health.

More Cath Labs Not the Solution

In an interview with TCTMD, Sorin J. Brener, MD, of Weill Cornell Medical College (New York, NY), said that the study highlights the minimal return on investment from the addition of cath labs.

“This capital investment has not really changed the availability or the access for people to get to a cath lab in a timely manner,” Dr. Brener noted.

Dr. Concannon and colleagues say that the study results “suggest that more frequent assessments of hospital PCI capacity are urgently needed.” However, Dr. Brener disagreed, pointing out that with about 80% of the population living within 1 hour of a PCI-capable hospital, access is good.

“I think the more concerning thing is that—although it is not proven—there may be a dilution of expertise,” Dr. Brener said. “The problem is that now that you have 44% more hospitals that do the same thing, a center that was performing 150 procedures will only do 60 or 70 in that same period.”

Instead, Dr. Brener suggested that further improvement in access to primary PCI will come not from building more cath labs but from strategies such as providing air transportation in rural areas or states that are sparsely populated.

 


Source:
Concannon TW, Nelson J, Goetz J, Griffith JL. A percutaneous coronary intervention lab in every hospital? Circ Cardiovasc Qual Outcomes. 2011;Epub ahead of print.

 

 

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Disclosures
  • Drs. Concannon and Brener report no relevant conflicts of interest.

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