Relationship of Distance to PCI Center With In-Hospital Mortality After STEMI: Insights From a Rural Regional STEMI Network.

Background: Patients who present with ST-elevation myocardial infarction (STEMI) to a hospital without primary percutaneous coronary intervention (PPCI) capability may be transferred for PPCI or receive fibrinolytic therapy, depending on whether the first medical contact to balloon time of ≤120 minutes can be achieved. We hypothesized that travel distance to the percutaneous coronary intervention (PCI) center might impact STEMI outcomes in a rural STEMI system of care. Methods: We retrospectively analyzed 6225 consecutive STEMI patients from the Northern New England Cardiovascular Disease Study Group registry from 2018 to 2023. Residential distance to care was calculated by road travel distance between ZIP Code centroids and grouped into quartiles. Patients were categorized by treatment strategy: initial presentation to a PCI center, transfer for PPCI, or pharmacoinvasive PCI. The primary outcome was in-hospital mortality. Multivariable logistic regression evaluated the association between residential distance and treatment strategy with in-hospital mortality. Results: The median residential distance to PCI center for STEMI patients in Northern New England was 38.2 miles (IQR, 47.1). Of the overall cohort, 44.4% (median travel distance: 17.2 miles) had index presentation to a PCI hospital, 23.8% (median travel distance: 40.1 miles) underwent interhospital transfer for primary PCI, and 31.9% (median travel distance: 66.5 miles) were transferred for pharmacoinvasive PCI after initial lytic therapy. There was no association between distance to PCI hospital and adjusted in-hospital mortality after STEMI, irrespective of the treatment group. Conclusions: In Northern New England with contemporary regional STEMI referral networks, distance to PCI hospital did not impact STEMI mortality despite substantial travel distances for many patients.