Community-Level Procedure Volume and Patient Health Profiles Following PCI-Capable Facility Openings.

Abstract

While the clinical benefits of timely percutaneous coronary intervention (PCI) are well established, it remains unclear whether the expansion of PCI-capable facilities enhances access to critical care or contributes to overuse. To assess whether new PCI-capable hospital openings are associated with changes in the overall procedural volume at the community level and the health characteristics of patients undergoing PCI. This cohort study used California all-payer data from January 1, 2011, to December 31, 2022, including 651 585 patients across 2348 communities (defined by zip code). Using a difference-in-differences framework, changes in PCI volume and patient characteristics in communities exposed to a PCI facility opening were compared with those without, stratified by baseline PCI access. Statistical analysis was completed between January and July 2025. Opening of a PCI-capable facility within a 30-minute driving time of a zip code community. Community-level PCI volume and patient-level indicators, including primary diagnosis of stable angina, prior acute myocardial infarction (AMI) or coronary artery bypass grafting (CABG), and procedure complexity (number of vessels treated). The final sample included 651 585 patients (463 526 male [71%]; 128 469 Hispanic [20%], 370 672 White [57%]); 47 003 patients (7%) lived in rural communities. At baseline, 84 349 patients (13%) had no access to PCI within 30 minutes. Community PCI volume increased by 7.5% (95% CI, 6.4%-8.6%) after a local PCI facility opened, with a 19.9% increase (95% CI, 15.7%-24.1%) in communities without prior 30-minute access. Among patients, the proportion with stable angina increased by 2.5 percentage points (95% CI, 2.0 to 3.1 percentage points), and by 3.5 percentage points (95% CI, 1.3 to 5.7 percentage points) in communities with no PCI at baseline. In communities with prior access, there was a 0.7 percentage point increase (95% CI, 0.3 to 1.1 percentage points) in patients without prior AMI or CABG and a 0.6 percentage point increase (95% CI, 0.4 to 0.9 percentage points) in those receiving PCI on 3 or more vessels. In contrast, communities with no baseline access to PCI experienced a 2.2 percentage point increase (95% CI, 0.3 to 4.1 percentage points) in single-vessel PCI and a 2.1 percentage point decrease (95% CI, -3.0 to -1.2 percentage points) in patients receiving PCI on 3 or more vessels. In this retrospective cohort study of 651 585 patients, the opening of PCI-capable hospitals was associated with increased community PCI volumes, particularly in underserved areas. Changes in patient profiles suggested potential supply-induced demand in areas that had existing access, and a release of unmet need in previously underserved areas; these findings highlighted the dual implications of service expansion.