{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T15:50:41Z","timestamp":1791820241179,"version":"4.3.4"},"reference-count":24,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n The proliferation of percutaneous coronary intervention (PCI) facilities across the US has raised questions about whether expanding capacity improves outcomes in areas already served vs those without prior access.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the association between the opening of PCI-capable facilities and outcomes following acute myocardial infarction (AMI) in communities with and without baseline PCI access.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study used California data from inpatient, emergency department, and ambulatory surgery encounters from January 1, 2011, to December 31, 2022, including all adults hospitalized with a primary diagnosis of AMI. Zip code communities were categorized by baseline (2011) access to PCI-capable facilities within a 30-minute drive.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Opening of a PCI-capable facility within 30 minutes of a community\u2019s zip code during the study period.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Primary outcomes were (1) admission to a PCI-capable facility, (2) receipt of PCI during the index hospitalization, (3) unscheduled acute care visit within 30 days, and (4) all-cause mortality at 30 days and 1 year. Linear probability models with community and time-fixed effects estimated changes in outcomes following PCI facility openings separately for communities with and without baseline access.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 590\u202f282 patients with AMI (157\u202f435 younger than age 60 years [27%]; 222\u202f773 female [38%]; 63\u202f460 Asian [11%], 129\u202f137 Hispanic [22%], 315\u202f326 White [53%]), 500\u202f778 (85%) lived in communities with baseline PCI access, and 89\u202f504 (15%) lived in communities without; 18\u202f805 patients (21%) without baseline access experienced a PCI opening. Openings in communities without baseline access were associated with a 30.0 percentage point (pp) increase (95% CI, 28.2 to 31.8 pp) in admission to PCI-capable hospitals and a 5.1 pp increase (95% CI, 3.3 to 7.0 pp) in PCI receipt, along with reductions in 30-day (\u20131.8 pp; 95% CI, \u20133.2 to \u20130.5 pp) and 1-year (\u20132.8 pp; 95% CI, \u20134.7 to \u20131.0 pp) mortality. In contrast, openings in communities with baseline access were associated with smaller gains in admission (1.5 pp; 95% CI, 1.1 to 1.9 pp), modest increases in PCI use (1.0 pp; 95% CI, 0.5 to 1.6 pp), decreases in unscheduled visits within 30 days (\u20130.7 pp; 95% CI, \u20131.2 to \u20130.2 pp), and no mortality change. Sensitivity analyses restricted to higher-volume PCI centers (50 annual cases or more) yielded consistent findings.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study of 590\u202f282 patients with AMI in California, opening new PCI facilities was associated with substantial improvements in communities without prior PCI availability, including a 53% relative increase in access to admission, 16% increase in PCI use, and 20% and 15% reductions in 30-day and 1-year mortality, respectively. In contrast, already served areas showed smaller benefits and no mortality improvement. PCI expansion should prioritize underserved regions to maximize population-level benefits and avoid inefficient duplication of services.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.38687","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T15:30:25Z","timestamp":1791819025000},"page":"e2638687","source":"Crossref","is-referenced-by-count":0,"title":["Percutaneous Coronary Intervention Facility Access and Clinical Outcomes Among Patients With Acute Myocardial Infarction"],"prefix":"10.1001","volume":"9","author":[{"given":"Yu-Chu","family":"Shen","sequence":"first","affiliation":[{"name":"Department of Acquisition, Finance, and Manpower, Naval Postgraduate School, Monterey, California"},{"name":"National Bureau of Economic Research, Cambridge, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renee Y.","family":"Hsia","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of California, San Francisco"},{"name":"Philip R. 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