Abstract 17083: Progress and Paradox in the Real World Penetration of Percutaneous Coronary Intervention for Treatment of ST-Elevation Myocardial Infarction

Abstract

Background: Much of the surveillance data on the use of percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) comes from patient registries with voluntary hospital participation or from Medicare data. Non-PCI capable hospitals are significantly underrepresented in registry data, and large hospitals are over-represented; consequently registry data is likely to signficantly overestimate the use of PCI in STEMI on a true population basis. Medicare data are more comprehensive, but include only the elderly population. In this study, we used an unselected population-based hospital surveillance system to investigate temporal trends in the use of PCI for STEMI in Florida from 2001-2009. Florida is the 4th largest state with over 18 million persons. Methods: We used statewide hospital discharge data, including detailed diagnosis and procedure codes to identify STEMI patients who did vs. did not receive same-day PCI. We created county maps for 2001, 2003, 2005, 2007, and 2009 to observe geographic disparities in the use of primary PCI. Data for over 100,000 STEMI patients were analyzed. Results: Statewide, same-day PCI for STEMI increased from 23.4% in 2001 to 63.5% in 2009. County-level maps revealed marked and persistent geographic disparities. In 2009, some major metropolitan areas fell below the state average, while some small rural counties had >80% of STEMI patients receiving PCI. Small urban counties with one non-PCI providing hospital had lower rates than many rural counties with no hospital. Counties with only one high-volume PCI center had the highest rates of primary PCI. Conclusions: Few studies have reported population-based rates of primary PCI usage. We found significant progress in the use of same-day PCI from 2001 to 2009 in Florida, but also paradox with some major metropolitan areas lagging behind smaller urban and rural areas. Rural counties adjacent to major metro areas with high-volume PCI centers had high rates of PCI usage. In contrast, major metro areas with many hospitals had average or below average usage rates. Our results suggest that excessive hospital competition creates barriers for STEMI patients to receive primary PCI.