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A study of 590,282 California heart attack hospitalizations from 2011 to 2022 found that opening a PCI-capable facility was associated with lower mortality when it brought timely access to communities that previously lacked it. In areas already within a 30-minute drive of PCI care, another facility did not significantly improve survival.
A new University of California, San Francisco-led study found that heart attack patients were more likely to survive when a new hospital equipped for emergency artery-opening procedures brought timely access to communities that previously lacked it. The analysis of 590,282 California hospitalizations found no significant mortality improvement when another such facility opened in places already within a 30-minute drive of one.
The study, published in JAMA Network Open, examined access to percutaneous coronary intervention, or PCI. The procedure restores blood flow through blocked arteries and may be used to treat heart attacks. Providing it requires specialized facilities, equipment and trained personnel. Researchers compared outcomes after a PCI-capable facility opened within a 30-minute drive, distinguishing communities that had timely access beforehand from those that did not.
In communities without prior access, a new facility was associated with a 53% relative increase in admission to a PCI-capable hospital and a 16% increase in patients receiving PCI. Thirty-day mortality declined 20% and one-year mortality declined 15% in this group, the researchers reported. These are relative changes as reported by the study; the source material does not provide the corresponding absolute mortality rates.
Where PCI was already available within 30 minutes, opening another facility was associated with a 2% increase in admissions to a PCI-capable hospital and a 3% increase in use of the procedure. Researchers found no significant change in mortality in those communities. The findings describe associations following facility openings; they do not establish that opening a facility alone caused every observed change.
Closing Gaps May Improve Survival
The results suggest that where specialized emergency capacity is placed can matter as much as whether overall capacity grows. New PCI services were associated with improved survival in places lacking timely access, while adding another nearby option in already served communities increased treatment only modestly and showed no significant survival benefit.
This distinction is relevant to decisions by hospitals and policymakers about investments in services that require expensive infrastructure and staff. The study authors said market demand, procedure volume and expected returns may influence where hospitals open services, but those factors may not direct investment to communities where it could yield the largest population health benefit. The findings do not show that every proposed facility would have the same effect; local travel times, patient needs and other care arrangements matter.
Rural communities had a substantial access gap in the study: among 52,756 rural heart attack patients, 81% lived in areas without a PCI-capable facility within a 30-minute drive at the beginning of the study period. That figure describes the study’s rural patients and baseline access, not all rural Californians or current conditions.
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How Researchers Measured Access
The researchers assessed nearly 12 years of California heart attack hospitalizations, from 2011 through 2022, and used a 30-minute drive as the measure of timely access to a PCI-capable facility. Their comparison separates the potential impact of filling a geographic gap from the impact of adding capacity where a nearby option already existed.
The study follows earlier work by researcher Renee Y. Hsia and colleagues on changes in PCI procedure volumes after hospitals added capacity. That earlier analysis found a 7.5% rise in procedures after a new facility opened, with an increase of nearly 20% in communities that previously lacked timely access and about 8% in places where PCI was already available. The current report examines whether changes in access and treatment were accompanied by differences in patient outcomes.
The journal citation identifies the paper as “Percutaneous Coronary Intervention Facility Access and Clinical Outcomes Among Patients With Acute Myocardial Infarction,” by Y.-C. Shen and R. Y. Hsia, published in JAMA Network Open in 2026. The source material does not specify the study’s full statistical methods or provide absolute mortality figures.
“Americans tend to think more is better, but where you put these services really matters.”
— Renee Y. Hsia, UCSF professor of emergency medicine and senior study author
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Limits of the Available Findings
The source material reports associations between facility openings, access and outcomes, but does not provide enough detail to assess all potential differences between communities or the study’s full statistical approach. The reported relative mortality reductions also come without absolute mortality rates, so the size of the change in percentage points cannot be determined from the supplied information.
The analysis concerns California hospitalizations from 2011 to 2022. It does not establish whether the same results would apply in other states, under different travel conditions, or to every hospital that adds PCI capability. The report also does not say whether all patients who received PCI were clinically eligible for the procedure, or how changes in ambulance routing and other care services factored into outcomes.
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Planning Around Local Access Gaps
The paper provides evidence for policymakers and hospital systems weighing where to place specialized emergency services, but the source material does not identify a specific next policy decision or planned follow-up study. Any application of the findings will require attention to local travel times, existing capacity and patient needs, rather than assuming that adding a facility produces the same results everywhere.
Readers looking for further detail can consult the published study and its methods for the definitions of access, outcome measures and statistical adjustments. The central question for future planning is whether proposed investments reach communities with a meaningful gap in timely PCI access, and whether the expected benefits hold in those settings.
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Key Questions
What is PCI?
Percutaneous coronary intervention is a procedure that restores blood flow through blocked arteries. It can be used to treat patients experiencing a heart attack and requires specialized equipment, facilities and personnel.
What did the study find where PCI was not already nearby?
When a new PCI-capable facility opened within a 30-minute drive of communities that previously lacked timely access, researchers reported increases in admission to a PCI-capable hospital and procedure use, alongside lower 30-day and one-year mortality. These findings are associations reported by the study.
Did another facility improve survival in areas already served?
The study found small increases in admission to PCI-capable hospitals and PCI use in communities that already had a facility within 30 minutes, but no significant change in mortality.
How many patients and what years did the study cover?
The analysis included 590,282 heart attack hospitalizations in California from 2011 through 2022.
Does the study prove that opening a facility caused lower mortality?
The supplied report describes changes associated with facility openings and does not establish that opening a facility alone caused all observed outcomes. The source material also does not provide absolute mortality rates or the full details needed to evaluate every possible influence on the results.
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