Population Density Analysis of Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction in
Kyohei Yamaji1, Shun Kohsaka2, Taku Inohara2,3
1Division of Cardiology Kokura Memorial Hospital Kitakyushu Japan.
Insights
Geographic disparities in ST-segment-elevation myocardial infarction treatment exist, with higher population density areas showing lower in-hospital mortality. More operators per institution may explain these improved outcomes for ST-elevation myocardial infarction patients.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- ST-segment-elevation myocardial infarction (STEMI) treatment has advanced, but geographic disparities in evidence-based therapy application persist.
- Limited data exists on how population density influences the delivery and outcomes of STEMI care.
Purpose of the Study:
- To investigate geographic disparities in in-hospital mortality among STEMI patients undergoing percutaneous coronary intervention (PCI).
- To explore the association between population density and PCI outcomes, including door-to-balloon time and mortality.
Main Methods:
- Analysis of the Japanese Percutaneous Coronary Intervention (J-PCI) registry data from 2014-2018, including 209,521 STEMI patients from 1126 institutions.
- Patients were stratified into tertiles based on the population density (PD) of their PCI institution's location.
- Statistical models were used to assess the correlation between PD, door-to-balloon time, number of operators, and in-hospital mortality, adjusting for baseline characteristics.
Main Results:
- No significant correlation was found between population density and door-to-balloon time.
- Patients in lower population density areas had higher crude and adjusted in-hospital mortality rates compared to those in high PD areas.
- Higher population density areas had more operators per institution, which was inversely associated with in-hospital mortality.
Conclusions:
- Geographic inequality in in-hospital mortality for STEMI patients undergoing PCI was observed.
- The number of operators per institution, not traditional quality indicators like door-to-balloon time, may be a key factor explaining these observed mortality differences.
Abstract:
Background Despite recent progress in the treatment of ST-segment-elevation myocardial infarction, data on geographic disparities application of the evidence-based therapy remain limited. Methods and Results The J-PCI (Japanese Percutaneous Coronary Intervention) registry is a nationwide registry to assure the quality of delivered care. Between January 2014 and December 2018, 209 521 patients underwent percutaneous coronary intervention for ST-segment-elevation myocardial infarction in 1126 institutions. The patients were divided into tertiles according to the population density (PD) of the percutaneous coronary intervention institution location (low: <951.7/km2, n = 69 797; medium: 951.7-4729.7/km2, n = 69 750; high: ≥4729.7/km2, n = 69 974). Patients treated in high PD administrative districts were younger and more likely to be male. No significant correlation was observed between PD and door-to-balloon time (regression coefficients: 0.036 per 1000 people/km2; 95% CI, -0.232 to 0.304; P = 0.79). Patients treated in low-PD areas had higher crude in-hospital mortality rates than those treated in high-PD areas (low: 2.89%; medium: 2.60%; high: 2.38%; P < 0.001); PD and in-hospital mortality had a significantly inverse association, before and after adjusting for baseline characteristics (crude odds ratio [OR], 0.983 per 1000/km2; 95% CI, 0.973-0.992; P < 0.001; adjusted OR, 0.980 per 1000/km2; 95% CI, 0.964-0.996; P = 0.01, respectively). Higher-PD districts had more operators per institution (low: 6; interquartile range, 3-10; medium: 7; IQR, 3-13; high: 8; IQR, 5-13; P < 0.001), suggesting an inverse association with in-hospital mortality (OR, 0.992; 95% CI, 0.986-0.999; P = 0.03). Conclusions Geographic inequality was observed in in-hospital mortality of patients with ST-segment-elevation myocardial infarction who underwent percutaneous coronary intervention. Variation in the number of operators per institution, rather than traditional quality indicators (eg, door-to-balloon time) might explain the difference in in-hospital mortality.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:26Coronary Artery Disease IV: Preventive Measures
01:30Coronary Artery Disease I: Introduction