Risk of delayed percutaneous coronary intervention for STEMI in the Southeast United States.

IF 3.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal Pub Date : 2025-05-13 DOI:10.1016/j.ahj.2025.05.002

Maxwell C Messinger, Nicklaus P Ashburn, Joshua S Chait, Anna C Snavely, Siena Hapig-Ward, Jason P Stopyra, Simon A Mahler

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引用次数: 0

Abstract

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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美国东南部STEMI患者延迟经皮冠状动脉介入治疗的风险

背景：对于st段抬高型心肌梗死（STEMI），经皮冠状动脉介入治疗（PCI）应在首次医疗接触后90分钟内再灌注，但在农村地区，运输时间长可能使其不太可能。我们试图量化美国东南部居民因运输而面临治疗延误的风险。方法：利用美国社区调查数据和地理信息系统（GIS）对美国东南部居民进行横断面研究，以估计紧急医疗服务（EMS）运送到初级PCI （PPCI）中心的时间。研究区域内的所有PPCI中心以及周边各州的中心均被纳入研究范围。主要结果是居住在距PPCI超过30分钟和60分钟的居民人数。这些截止时间是基于全国EMS现场时间和门到设备时间的中位数，分别对应于fmc到设备的估计时间为90分钟和120分钟。次要结果是确定超过50%和90%的人口存在治疗延误风险的县。结果：在研究区域的62,880,528名居民中，我们确定了近1100万人有延迟PCI的风险（17.3%,10,866,710±58,143）。其中，1271522例（±51858例）患者离PPCI超过60分钟。我们发现，8.4%（52/616）的县有超过50%的人口面临治疗延误的风险。42.3%（22/52）的人有超过90%的风险。结论：美国东南部近1100万人没有及时获得PCI。这种差异可能导致发病率和死亡率增加。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American heart journal 医学-心血管系统

CiteScore

8.20

自引率

2.10%

发文量

214

审稿时长

38 days

期刊介绍： The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.