Access to myocardial revascularization procedures: closing the gap with time?

Area of Science:

• Cardiology
• Public Health
• Health Services Research

Background:

• Early revascularization improves outcomes for myocardial infarction (MI) patients.
• Access to specialized cardiac care varies significantly across populations.
• Geographic distance to specialized cardiology centers (SCCs) may influence revascularization rates.

Purpose of the Study:

• To determine if the initial disparity in revascularization rates, based on patient proximity to SCCs, persists long-term.
• To analyze the evolution of revascularization rate gaps over the first year after MI.

Main Methods:

• Population-based cohort study using Quebec's hospital discharge register (MED-ECHO).
• Included 11,802 patients aged 25+ hospitalized for MI in 1999, with one-year follow-up.
• Categorized patients into four distance groups from SCCs (<32 km, 32-64 km, 64-105 km, > or = 105 km).
• Main outcome: revascularization (PCI or CABG); adjusted for age and sex.

Main Results:

• A significant gap in revascularization rates existed at index hospitalization, favoring patients closer to SCCs (<32 km).
• This gap persisted throughout the first year post-MI.
• A notable reduction in the revascularization gap was observed for patients living at an intermediate distance (64-105 km).

Conclusions:

• The initial disparity in MI revascularization rates based on distance to SCCs is largely maintained one year post-MI.
• Patients living closer to specialized centers have better access to timely revascularization.
• Intermediate distance patients (64-105 km) showed some improvement in gap reduction over the first year.