Abstract
Introduction_ Percutaneous coronary intervention (PCI) is considered the preferred reperfusion therapy in patients with ST-elevated myocardial infarction (STEMI). Despite compelling evidence regarding the benefits of timely reperfusion using PCI, many STEMI patients present to or are transported to non-PCI-capable hospitals. This study identified the spatial distribution of STEMI patient residences for those admitted to non-PCI-capable hospitals in Miami-Dade County and evaluated the proximity of these patients to PCI-providing hospitals. Methods_ First admissions of Florida residents diagnosed with a STEMI (ICD-9-CM codes 410.0 - 410.6, 410.8) to a Miami-Dade County hospital in 2007 were identified using a comprehensive inpatient surveillance system database. Residential zipcodes were available for all patients. Geographic information systems were used to geocode 22 hospitals (13 non-PCI-capable and nine medium/high volume PCI hospitals) and map the percent of STEMI patients admitted to non-PCI-capable hospitals at the 5-digit zip code level. Results_ Miami-Dade is the 9th most populous county in the U.S., with 5 hospitals that performed >400 PCIs in 2007.Whereas the 13 non-PCI-capable hospitals were scattered throughout the county, the 9 PCI-capable hospitals were located primarily in the northeast quadrant. In 2007, 17.1% of 1,143 STEMI patients were admitted to non-PCI capable hospitals. Despite being located within 6 miles of a PCI-capable hospital, 6 zip codes within the northeast region had more than 50% of their STEMI patients admitted to a non-PCI-capable hospital. Zip codes located in the southwestern quadrant were between 9 and 20 miles from a PCI-capable hospital. The percent of STEMI patients residing in these zip codes who were admitted to non-PCI-capable hospitals varied from 50-60% (2), 25-50% (5), and 11% (1). Conclusions_ Despite residing in close proximity to a number of PCI-capable hospitals, many STEMI patients in Miami-Dade county were admitted to a non-PCI-capable hospital in 2007. Our results suggest that a high degree of hospital competition may not improve quality of care for STEMI patients.
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