Risk of delayed percutaneous coronary intervention for STEMI in the Southeast United States
Maxwell C Messinger1, Nicklaus P Ashburn2, Joshua S Chait2
1Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Family Medicine and Community Health, UMass Chan School of Medicine, Worcester, MA.
Insights
Nearly 11 million people in the Southeast US face delayed access to percutaneous coronary intervention (PCI) due to long emergency medical services (EMS) transport times. This lack of timely treatment for ST-segment elevation myocardial infarction (STEMI) may increase health risks.
Area of Science:
- Cardiovascular Medicine and Public Health
- Health Services Research
- Geographic Information Systems (GIS) in Healthcare
Background:
- Timely percutaneous coronary intervention (PCI) is critical for ST-segment elevation myocardial infarction (STEMI) treatment, aiming for reperfusion within 90 minutes of first medical contact (FMC).
- Long emergency medical services (EMS) transport times in rural Southeast US areas present a significant barrier to achieving guideline-recommended PCI treatment timelines.
- Quantifying the population at risk of delayed PCI due to transport is essential for understanding and addressing healthcare disparities.
Purpose of the Study:
- To estimate the number of Southeast US residents at risk of delayed primary PCI (PPCI) due to emergency medical services (EMS) transport times.
- To identify geographic areas and populations disproportionately affected by long transport times to PPCI centers.
Main Methods:
- A cross-sectional study utilized American Community Survey data and geographic information systems (GIS) to model EMS transport times to primary PCI (PPCI) centers in the Southeast US.
- Analysis focused on estimating the number of residents living more than 30 and 60 minutes from PPCI centers, correlating with estimated first medical contact-to-device times.
- Counties were assessed for the proportion of their population at risk of treatment delay (greater than 50% and 90% affected).
Main Results:
- Approximately 10.87 million Southeast US residents (17.3% of the total population) are at risk of delayed PCI.
- Over 1.27 million residents live more than 60 minutes away from a PPCI center, indicating significant access challenges.
- 8.4% of counties have over 50% of their population at risk of delayed treatment, with 42.3% of these counties having over 90% of their population affected.
Conclusions:
- A substantial population in the Southeast US lacks timely access to PCI, highlighting a critical healthcare access gap.
- These findings suggest that geographic and transport-related barriers contribute to significant disparities in STEMI care.
- The identified disparities in PCI access may lead to increased morbidity and mortality among affected populations.
Background:
While percutaneous coronary intervention (PCI) reperfusion within 90 minutes of first medical contact (FMC) is indicated for ST-segment elevation myocardial infarction (STEMI), long transport times in rural areas can make this unlikely. We sought to quantify Southeast US residents at risk of treatment delay due to transport.
Methods:
A cross-sectional study of Southeast US residents was conducted using American Community Survey data and geographic information systems (GIS) to estimate emergency medical services (EMS) transport times to primary PCI (PPCI) centers. All PPCI centers in the study area were included, as well as centers in surrounding states. The main outcomes were the number of residents residing more than 30 and 60 minutes from PPCI. These cutoffs are based on national median EMS scene times and door-to-device times and correspond to estimated FMC-to-device times of 90 and 120 minutes, respectively. A secondary outcome was identification of counties with greater than 50% and 90% of their population at risk of treatment delay.
Results:
Of 62,880,528 residents in the study area, we identified nearly 11 million at risk of delayed PCI (17.3%, 10,866,710 ± 58,143). Of those, 1,271,522 (± 51,858) live greater than 60 minutes from PPCI. We found that 8.4% (52/616) of counties have more than 50% of their population at risk of treatment delay. 42.3% (22/52) of those have more than 90% of at risk.
Conclusions:
Nearly 11 million people in the Southeast US do not have timely access to PCI. This disparity may contribute to increased morbidity and mortality.
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