Risk of Delayed Percutaneous Coronary Intervention for STEMI in the Southeast United States
Maxwell C Messinger1,2, Nicklaus P Ashburn1, Joshua S Chait1,3
1Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Insights
Nearly 11 million people in the Southeast US face delayed access to primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) due to long emergency transport times. This lack of timely reperfusion care may increase patient mortality and morbidity.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Timely reperfusion therapy via percutaneous coronary intervention (PCI) within 90 minutes of first medical contact (FMC) is critical for ST-segment elevation myocardial infarction (STEMI) patients.
- Prolonged emergency medical services (EMS) transport times in rural Southeastern US regions pose a significant barrier to achieving guideline-recommended FMC-to-device times.
- Understanding the geographic distribution of residents with extended transport times to 24/7 primary PCI (PPCI) centers is essential for addressing healthcare disparities.
Purpose of the Study:
- To quantify the number of residents in the Southeastern US experiencing prolonged transport times to the nearest 24/7 primary PCI (PPCI) center.
- To identify populations at risk for delayed treatment initiation for STEMI due to transportation barriers.
- To inform strategies aimed at improving access to time-sensitive STEMI care in underserved regions.
Main Methods:
- A cross-sectional study utilizing geographic information system (GIS) analysis with ArcGIS Pro.
- Estimation of EMS transport times from residential locations to all 24/7 PPCI centers within the Southeastern US (North Carolina, South Carolina, Georgia, Florida, Mississippi, Alabama, Tennessee) and adjacent states.
- Definition of primary outcome as >30 minutes transport time and secondary outcome as >60 minutes transport time, based on national EMS and door-to-device time data.
Main Results:
- Approximately 17.3% (10.87 million) of Southeast US residents live more than 30 minutes from a PPCI center, with 2% (1.27 million) living over 60 minutes away.
- While the majority of residents (82.7%) are within a 30-minute transport zone, significant populations face delays.
- A notable proportion of counties (8.4%) have over 50% of their population in long transport zones (>30 minutes), with 42.3% of these having >90% of their population in such zones.
Conclusions:
- Nearly 11 million individuals in the Southeast US lack access to timely PCI for STEMI treatment due to transportation challenges.
- This significant access gap represents a critical public health issue that may exacerbate STEMI-related morbidity and mortality in the region.
- Targeted interventions and infrastructure improvements are necessary to mitigate transport delays and ensure equitable STEMI care across the Southeast.
Background:
Emergent reperfusion by percutaneous coronary intervention (PCI) within 90 minutes of first medical contact (FMC) is indicated in patients with ST-segment elevation myocardial infarction (STEMI). However, long transport times in rural areas in the Southeast US make meeting this goal difficult. The objective of this study was to determine the number of Southeast US residents with prolonged transport times to the nearest 24/7 primary PCI (PPCI) center.
Methods:
A cross-sectional study of residents in the Southeastern US was conducted based on geographical and 2022 5-Year American Community Survey data. The geographic information system (GIS) ArcGIS Pro was used to estimate Emergency Medical Services (EMS) transport times for Southeast US residents to the nearest PPCI center. All 24/7 PPCI centers in North Carolina, South Carolina, Georgia, Florida, Mississippi, Alabama, and Tennessee were included in the analysis, as well as nearby PPCI centers in surrounding states. To identify those at risk of delayed FMC-to-device time, the primary outcome was defined as a >30-minute transport time, beyond which most patients would not have PCI within 90 minutes. A secondary outcome was defined as transport >60 minutes, the point at which FMC-to-device time would be >120 minutes most of the time. These cutoffs are based on national median EMS scene times and door-to-device times.
Results:
Within the Southeast US, we identified 62,880,528 residents and 350 PPCI centers. Nearly 11 million people living in the Southeast US reside greater than 30 minutes from a PPCI center (17.3%, 10,866,710, +/- 58,143), with 2% (1,271,522 +/- 51,858) living greater than 60 minutes from a PPCI hospital. However, most patients reside in short transport zones; 82.7% (52,013,818 +/- 98,741). Within the Southeast region, 8.4% (52/616) of counties have more than 50% of their population in a long transport zone and 42.3% (22/52) of those have more than 90% of their population in long transport areas.
Conclusions:
Nearly 11 million people in the Southeast US do not have access to timely PCI for STEMI care. This disparity may contribute to increased morbidity and mortality.
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