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Percutaneous Coronary Intervention in the United States: Risk Factors for Untimely Access

Keywords: Myocardial infarction; disparities.

Objective: To determine how access to percutaneous coronary intervention (PCI) is distributed across demographics.

Data Sources: Secondary data from the 2011 American Hospital Association (AHA) survey data combined with 2010 Census.

Study Design: We calculated prehospital times from 32,370 ZIP codes to the nearest PCI center. We used a multivariate logit model to determine the odds of untimely access by the ZIP code's concentration of vulnerable populations.

Data Collection: We used ZIP code–level data on community characteristics from the 2010 Census and supplemented it with 2011 AHA survey data on service-line availability of PCI for responding hospitals.

Principal Findings: For approximately 306 million Americans, the median prehospital time to the nearest PCI center is 33 minutes. While 84 percent of Americans live within one hour of a PCI center, the odds of untimely access are higher in low-income (OR: 3.00; 95 percent CI: 2.39, 3.77), rural (8.10; 95 percent CI: 6.84, 9.59), and highly Hispanic communities (2.55; 95 percent CI: 1.86, 3.49).

Conclusions: While the majority of Americans live within 60 minutes of a PCI center, rural, low-income, and highly Hispanic communities have worse PCI access. This may translate into worse outcomes for patients with acute myocardial infarction.

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