JAMA Netw Open. 2026 Mar 2;9(3):e262420. doi: 10.1001/jamanetworkopen.2026.2420.
ABSTRACT
IMPORTANCE: 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.
OBJECTIVE: 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.
DESIGN, SETTING, AND PARTICIPANTS: 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.
EXPOSURES: Opening of a PCI-capable facility within a 30-minute driving time of a zip code community.
MAIN OUTCOMES AND MEASURES: 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).
RESULTS: 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.
CONCLUSIONS AND RELEVANCE: 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.
PMID:41910975 | DOI:10.1001/jamanetworkopen.2026.2420
