Outcomes of coronary angioplasty procedures performed in rural hospitals.

PURPOSE

To determine how many rural hospitals in the United States performed coronary angioplasty; to compare patient outcomes in rural and urban hospitals; and to assess whether outcomes were better in rural hospitals in which more procedures were performed.

SUBJECTS AND METHODS

In 1996, among patients 65 years of age and older, 201,869 coronary angioplasties were performed in 996 hospitals that were included in the Medicare Provider Analysis and Review files. Geographic location was defined as rural or urban, according to U.S. Census Bureau criteria. Outcome variables were in-hospital death and coronary artery bypass surgery performed during the same admission. Hospital volumes were categorized as low (< or = 100 cases or fewer per year), medium (101 to 200 cases per year), or high (> 200 cases per year).

RESULTS

Fifty-one rural hospitals accounted for 4% of all angioplasties performed. After angioplasty, in-hospital mortality was greater in rural hospitals (8.1% versus 6.4%, P = 0.001) among patients with acute myocardial infarction, but was not different for patients without infarction (1.4% versus 1.3%, P = 0.41). Coronary artery bypass surgery rates during the same admission were similar in rural and urban hospitals. In general, in-hospital mortality and same-admission surgery rates were lower in high-volume centers in both rural and urban areas.

CONCLUSION

Although in-hospital mortality after angioplasty for acute myocardial infarction was worse in low- and medium-volume rural centers, overall outcomes in rural and urban hospitals were similar.