{
  "abstract": "Importance: The proliferation of percutaneous coronary intervention (PCI) facilities across the US has raised questions about whether expanding capacity improves outcomes in areas already served vs those without prior access.\n\nObjective: To evaluate the association between the opening of PCI-capable facilities and outcomes following acute myocardial infarction (AMI) in communities with and without baseline PCI access.\n\nDesign, Setting, and Participants: This cohort study used California data from inpatient, emergency department, and ambulatory surgery encounters from January 1, 2011, to December 31, 2022, including all adults hospitalized with a primary diagnosis of AMI. Zip code communities were categorized by baseline (2011) access to PCI-capable facilities within a 30-minute drive.\n\nExposure: Opening of a PCI-capable facility within 30 minutes of a community’s zip code during the study period.\n\nMain Outcomes and Measures: Primary outcomes were (1) admission to a PCI-capable facility, (2) receipt of PCI during the index hospitalization, (3) unscheduled acute care visit within 30 days, and (4) all-cause mortality at 30 days and 1 year. Linear probability models with community and time-fixed effects estimated changes in outcomes following PCI facility openings separately for communities with and without baseline access.\n\nResults: Among 590 282 patients with AMI (157 435 younger than age 60 years [27%]; 222 773 female [38%]; 63 460 Asian [11%], 129 137 Hispanic [22%], 315 326 White [53%]), 500 778 (85%) lived in communities with baseline PCI access, and 89 504 (15%) lived in communities without; 18 805 patients (21%) without baseline access experienced a PCI opening. Openings in communities without baseline access were associated with a 30.0 percentage point (pp) increase (95% CI, 28.2 to 31.8 pp) in admission to PCI-capable hospitals and a 5.1 pp increase (95% CI, 3.3 to 7.0 pp) in PCI receipt, along with reductions in 30-day (–1.8 pp; 95% CI, –3.2 to –0.5 pp) and 1-year (–2.8 pp; 95% CI, –4.7 to –1.0 pp) mortality. In contrast, openings in communities with baseline access were associated with smaller gains in admission (1.5 pp; 95% CI, 1.1 to 1.9 pp), modest increases in PCI use (1.0 pp; 95% CI, 0.5 to 1.6 pp), decreases in unscheduled visits within 30 days (–0.7 pp; 95% CI, –1.2 to –0.2 pp), and no mortality change. Sensitivity analyses restricted to higher-volume PCI centers (50 annual cases or more) yielded consistent findings.\n\nConclusions and Relevance: In this cohort study of 590 282 patients with AMI in California, opening new PCI facilities was associated with substantial improvements in communities without prior PCI availability, including a 53% relative increase in access to admission, 16% increase in PCI use, and 20% and 15% reductions in 30-day and 1-year mortality, respectively. In contrast, already served areas showed smaller benefits and no mortality improvement. PCI expansion should prioritize underserved regions to maximize population-level benefits and avoid inefficient duplication of services.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Acquisition, Finance, and Manpower, Naval Postgraduate School, Monterey, California",
    "Department of Emergency Medicine, University of California, San Francisco"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 2,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Yu-Chu Shen"
    },
    {
      "affs": [
        1
      ],
      "name": "Renee Y. Hsia"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/2mx5k9g9rz8c1.bib",
  "cited_by": 0,
  "doi": "10.1001/jamanetworkopen.2026.38687",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659571/?tool=EBI",
  "id": "2mx5k9g9rz8c1",
  "issns": [
    "2574-3805"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13659571",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2705|Acute Myocardial Infarction Research"
    ]
  ],
  "openalex": "W7221512650",
  "pdf_url": null,
  "pmcid": "PMC13659571",
  "pmid": null,
  "published": "2026-10-01",
  "publisher": "American Medical Association (AMA)",
  "ris": "https://research.draconitic.com/paper/2mx5k9g9rz8c1.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:31Z",
      "native_id": "PMC:PMC13659571",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13659571"
    },
    {
      "first_seen": "2026-10-30T12:19:46Z",
      "native_id": "10.1001/jamanetworkopen.2026.38687",
      "source": "crossref",
      "url": "https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855215"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Acute Myocardial Infarction Research",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Percutaneous Coronary Intervention Facility Access and Clinical Outcomes Among Patients With Acute Myocardial Infarction",
  "title_text": "Percutaneous Coronary Intervention Facility Access and Clinical Outcomes Among Patients With Acute Myocardial Infarction",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:46Z",
  "url": "https://research.draconitic.com/paper/2mx5k9g9rz8c1",
  "venue": "JAMA network open",
  "versions": []
}