Barriers to Timely Percutaneous Coronary Intervention (PCI) in Rural vs. Urban Settings: A Health System Approach

Area of Science:

• Cardiology
• Public Health
• Health Services Research

Background:

• Timely primary percutaneous coronary intervention (PCI) is critical for managing ST-elevation myocardial infarction (STEMI), reducing patient morbidity and mortality.
• Rural populations often encounter substantial geographic, patient-related, and system-level barriers to timely PCI.
• Disparities in reperfusion times between rural and urban STEMI patients necessitate investigation into contributing factors.

Purpose of the Study:

• To compare barriers to timely PCI in rural versus urban STEMI patients.
• To identify independent predictors of treatment delay in STEMI patients.
• To quantify the impact of identified barriers on reperfusion times.

Main Methods:

• A cross-sectional study involving 273 STEMI patients undergoing primary PCI (137 rural, 136 urban).
• Data collected via structured questionnaires and medical record review, assessing patient- and system-level barriers.
• Multivariate logistic regression analysis adjusted for covariates to identify predictors of PCI delay.

Main Results:

• Rural patients experienced significantly longer door-to-balloon (105.5 vs. 84.1 min) and symptom-to-door (295 vs. 145 min) times compared to urban patients.
• Delays exceeding 90 minutes occurred in 82.5% of rural versus 27.9% of urban patients.
• Rural residence, patient-related barriers, and system-related barriers were independent predictors of PCI delay.

Conclusions:

• Rural STEMI patients face significant delays in primary PCI, driven by patient and system-level barriers.
• Targeted interventions in health education, pre-hospital transport, and referral processes are vital.
• Reducing rural-urban disparities in PCI access is essential for improving clinical outcomes and adhering to reperfusion guidelines.