Center for Clinical and Epidemiologic Research, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China.
Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China.
Int J Environ Res Public Health. 2023 Feb 10;20(4):3166. doi: 10.3390/ijerph20043166.
Timely arrival at a hospital capable of percutaneous coronary intervention (PCI) is critical in treating acute myocardial infarction (AMI). We examined the association between driving time to the nearest PCI-capable hospital and case fatality among AMI patients. A total of 142,474 AMI events during 2013-2019 from the Beijing Cardiovascular Disease Surveillance System were included in this cross-sectional study. The driving time from the residential address to the nearest PCI-capable hospital was calculated. Logistic regression was used to estimate the risk of AMI death associated with driving time. In 2019, 54.5% of patients lived within a 15-min drive to a PCI-capable hospital, with a higher proportion in urban than peri-urban areas (71.2% vs. 31.8%, < 0.001). Compared with patients who had driving times ≤15 min, the adjusted odds ratios (95% CI, value) for AMI fatality risk associated with driving times 16-30, 31-45, and >45 min were 1.068 (95% CI 1.033-1.104, < 0.001), 1.189 (95% CI 1.127-1.255, < 0.001), and 1.436 (95% CI 1.334-1.544, < 0.001), respectively. Despite the high accessibility to PCI-capable hospitals for AMI patients in Beijing, inequality between urban and peri-urban areas exists. A longer driving time is associated with an elevated AMI fatality risk. These findings may help guide the allocation of health resources.
及时到达能够进行经皮冠状动脉介入治疗（PCI）的医院对于急性心肌梗死（AMI）的治疗至关重要。我们研究了从最近的 PCI 医院的驾驶时间与 AMI 患者的病例死亡率之间的关系。这项横断面研究纳入了 2013 年至 2019 年期间来自北京市心血管疾病监测系统的 142474 例 AMI 事件。计算了从居住地址到最近的 PCI 医院的驾驶时间。使用 logistic 回归估计与驾驶时间相关的 AMI 死亡风险。2019 年，54.5%的患者居住在距离 PCI 医院 15 分钟车程内，城市地区的比例高于城郊地区（71.2% vs. 31.8%，<0.001）。与驾驶时间≤15 分钟的患者相比，驾驶时间 16-30、31-45 和>45 分钟的 AMI 死亡率的校正比值比（95%置信区间， 值）分别为 1.068（95%CI 1.033-1.104，<0.001）、1.189（95%CI 1.127-1.255，<0.001）和 1.436（95%CI 1.334-1.544，<0.001）。尽管北京的 AMI 患者能够获得 PCI 医院的高可及性，但城市和城郊地区之间存在不平等。驾驶时间越长，AMI 死亡率风险越高。这些发现可能有助于指导卫生资源的分配。
