Messinger Maxwell C, Ashburn Nicklaus P, Chait Joshua S, Snavely Anna C, Hapig-Ward Siena, Stopyra Jason P, Mahler Simon A
Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Department of Family Medicine and Community Health, UMass Chan School of Medicine, Worcester, MA, USA.
medRxiv. 2024 Jul 12:2024.07.11.24310307. doi: 10.1101/2024.07.11.24310307.
Emergent reperfusion by percutaneous coronary intervention (PCI) within 90 minutes of first medical contact (FMC) is indicated in patients with ST-segment elevation myocardial infarction (STEMI). However, long transport times in rural areas in the Southeast US make meeting this goal difficult. The objective of this study was to determine the number of Southeast US residents with prolonged transport times to the nearest 24/7 primary PCI (PPCI) center.
A cross-sectional study of residents in the Southeastern US was conducted based on geographical and 2022 5-Year American Community Survey data. The geographic information system (GIS) ArcGIS Pro was used to estimate Emergency Medical Services (EMS) transport times for Southeast US residents to the nearest PPCI center. All 24/7 PPCI centers in North Carolina, South Carolina, Georgia, Florida, Mississippi, Alabama, and Tennessee were included in the analysis, as well as nearby PPCI centers in surrounding states. To identify those at risk of delayed FMC-to-device time, the primary outcome was defined as a >30-minute transport time, beyond which most patients would not have PCI within 90 minutes. A secondary outcome was defined as transport >60 minutes, the point at which FMC-to-device time would be >120 minutes most of the time. These cutoffs are based on national median EMS scene times and door-to-device times.
Within the Southeast US, we identified 62,880,528 residents and 350 PPCI centers. Nearly 11 million people living in the Southeast US reside greater than 30 minutes from a PPCI center (17.3%, 10,866,710, +/- 58,143), with 2% (1,271,522 +/- 51,858) living greater than 60 minutes from a PPCI hospital. However, most patients reside in short transport zones; 82.7% (52,013,818 +/- 98,741). Within the Southeast region, 8.4% (52/616) of counties have more than 50% of their population in a long transport zone and 42.3% (22/52) of those have more than 90% of their population in long transport areas.
Nearly 11 million people in the Southeast US do not have access to timely PCI for STEMI care. This disparity may contribute to increased morbidity and mortality.
对于ST段抬高型心肌梗死（STEMI）患者，建议在首次医疗接触（FMC）后90分钟内通过经皮冠状动脉介入治疗（PCI）进行紧急再灌注。然而，美国东南部农村地区较长的转运时间使得实现这一目标变得困难。本研究的目的是确定美国东南部居民中转运至最近的24/7初级PCI（PPCI）中心时间延长的人数。
基于地理信息和2022年美国社区5年调查数据对美国东南部居民进行了一项横断面研究。使用地理信息系统（GIS）ArcGIS Pro估算美国东南部居民到最近的PPCI中心的紧急医疗服务（EMS）转运时间。分析纳入了北卡罗来纳州、南卡罗来纳州、佐治亚州、佛罗里达州、密西西比州、阿拉巴马州和田纳西州的所有24/7 PPCI中心，以及周边州的附近PPCI中心。为了确定那些FMC至器械时间延迟风险较高的人群，主要结局定义为转运时间>30分钟，超过此时间大多数患者无法在90分钟内接受PCI治疗。次要结局定义为转运时间>60分钟，此时FMC至器械时间大多数情况下将>120分钟。这些临界值基于全国EMS现场时间和门至器械时间的中位数。
在美国东南部，我们确定了62880528名居民和350个PPCI中心。美国东南部近1100万人居住在距离PPCI中心超过30分钟路程的地方（17.3%，10866710人，±58143人），其中2%（1271522人±51858人）居住在距离PPCI医院超过60分钟路程的地方。然而，大多数患者居住在短转运区域；82.7%（52013818人±98741人）。在东南部地区，8.4%（52/616）的县有超过50%的人口处于长转运区域，其中42.3%（22/52）的县有超过90%的人口处于长转运区域。
美国东南部近1100万人无法及时获得STEMI治疗的PCI服务。这种差异可能导致发病率和死亡率上升。
