Heart Attack Mortality Fell After PCI Openings in Areas Without Access

Opening new percutaneous coronary intervention (PCI) facilities was associated with improved access, treatment, and survival for patients with acute myocardial infarction (AMI) in California communities without prior PCI access, but not with lower mortality in communities already served, according to a cohort study published in JAMA Network Open.

The investigators analyzed California inpatient, emergency department, and ambulatory surgery data on 590,282 adults hospitalized with a primary diagnosis of AMI from 2011 to 2022. Zip code communities were classified by whether a PCI-capable facility was within a 30 minute drive in 2011; 85% of patients lived in communities with baseline access and 15% in communities without. Linear probability models with community and time-fixed effects estimated changes in outcomes after a facility opened within 30 minutes.

In communities without baseline access, openings were associated with a 30.0 percentage point (pp) increase in admission to PCI-capable hospitals (95% CI, 28.2-31.8pp) and a 5.1pp increase in PCI receipt. Thirty-day mortality fell by 1.8pp (95% CI, −3.2 to −0.5pp) and 1-year mortality by 2.8pp (95% CI, −4.7 to −1.0pp), corresponding to relative reductions of 20% and 15%, respectively.

In communities with baseline access, openings were associated with smaller gains in admission (1.5pp) and PCI use (1.0pp), a 0.7pp decrease in unscheduled acute care visits within 30 days, and no change in mortality. Results were consistent when the analysis was restricted to higher-volume centers performing at least 50 PCIs annually. Among patients in rural communities, 81% lived in communities with no baseline PCI access.

The authors noted that the study relied on administrative data lacking clinical details such as infarct size and ischemic time, may not be generalizable beyond California, and shows association rather than causality. They concluded that PCI expansion should prioritize underserved regions to maximize population-level benefits and avoid duplication of services.

Source: Shen YC, Hsia RY. Percutaneous coronary intervention facility access and clinical outcomes among patients with acute myocardial infarction. JAMA Netw Open. 2026;9(10):e2638687. doi:10.1001/jamanetworkopen.2026.38687