University of Texas Health Sciences Center, Houston, TX.
J Am Heart Assoc. 2013 Oct 28;2(6):e000370. doi: 10.1161/JAHA.113.000370.
The access to and growth of percutaneous coronary intervention (PCI) has not been fully explored with regard to geographic equity and need. Economic factors and timely access to primary PCI provide the impetus for growth in PCI centers, and this is balanced by volume standards and the benefits of regionalized care.
Geospatial and statistical analyses were used to model capacity, growth, and access of PCI hospitals relative to population density and myocardial infarction (MI) prevalence at the state level. Longitudinal data were obtained for 2003-2011 from the American Hospital Association, the U.S. Census, and the Centers for Disease Control and Prevention (CDC) with geographical modeling to map PCI locations. The number of PCI centers has grown 21.2% over the last 8 years, with 39% of all hospitals having interventional cardiology capabilities. During the same time, the US population has grown 8.3%, from 217 million to 235 million, and MI prevalence rates have decreased from 4.0% to 3.7%. The most densely concentrated states have a ratio of 8.1 to 12.1 PCI facilities per million of population with significant variability in both MI prevalence and average distance between PCI facilities.
Over the last decade, the growth rate for PCI centers is 1.5× that of the population growth, while MI prevalence is decreasing. This has created geographic imbalances and access barriers with excess PCI centers relative to need in some regions and inadequate access in others.
关于经皮冠状动脉介入治疗（PCI）的获取和发展，在地理公平性和需求方面尚未得到充分探讨。经济因素和及时进行直接经皮冠状动脉介入治疗为 PCI 中心的发展提供了动力，而这与容量标准和区域化护理的效益相平衡。
利用地理空间和统计分析，对各州 PCI 医院的容量、增长和获取情况进行建模，以评估其与人口密度和心肌梗死（MI）患病率的关系。从美国医院协会、美国人口普查局和疾病控制与预防中心（CDC）获取了 2003 年至 2011 年的纵向数据，并进行了地理建模以绘制 PCI 地点。过去 8 年来，PCI 中心的数量增长了 21.2%，有 39%的医院具备介入心脏病学能力。在此期间，美国人口增长了 8.3%，从 2.17 亿增长到 2.35 亿，而 MI 患病率从 4.0%下降到 3.7%。人口最密集的州每百万人口拥有 8.1 至 12.1 个 PCI 设施，MI 患病率和 PCI 设施之间的平均距离都存在显著差异。
在过去十年中，PCI 中心的增长率是人口增长率的 1.5 倍，而 MI 患病率正在下降。这导致了地理不平衡和获取障碍，一些地区 PCI 中心过多，而另一些地区则无法获得足够的服务。
