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Open Access Research article

Access to myocardial revascularization procedures: Closing the gap with time?

Alain Vanasse12*, Théophile Niyonsenga23, Josiane Courteau2 and Abbas Hemiari2

Author Affiliations

1 Family Medicine Department, Faculty of Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke (QC), J1H 5N4, Canada

2 PRIMUS Group, Clinical Research Center, Sherbrooke University Hospital, Sherbrooke (QC), Canada

3 Epidemiology & Biostatistics, Stempel School of Public Health, Florida International University (FIU), USA

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BMC Public Health 2006, 6:60  doi:10.1186/1471-2458-6-60

Published: 8 March 2006

Abstract

Background

Early access to revascularization procedures is known to be related to a more favorable outcome in myocardial infarction (MI) patients, but access to specialized care varies widely amongst the population. We aim to test if the early gap found in the revascularization rates, according to distance between patients' location and the closest specialized cardiology center (SCC), remains on a long term basis.

Methods

We conducted a population-based cohort study using data from the Quebec's hospital discharge register (MED-ECHO). The study population includes all patients 25 years and older living in the province of Quebec, who were hospitalized for a MI in 1999 with a follow up time of one year after the index hospitalization. The main variable is revascularization (percutaneous transluminal coronary angioplasty or a coronary artery bypass graft). The population is divided in four groups depending how close they are from a SCC (<32 km, 32–64 km, 64–105 km and ≥105 km). Revascularization rates are adjusted for age and sex.

Results

The study population includes 11,802 individuals, 66% are men. The one-year incidence rate of MI is 244 individuals per 100,000 inhabitants. At index hospitalization, a significant gap is found between patients living close (< 32 km) to a SCC and patients living farther (≥32 km). During the first year, a gap reduction can be observed but only for patients living at an intermediate distance from the specialized center (64–105 km).

Conclusion

The gap observed in revascularization rates at the index hospitalization for MI is in favour of patients living closer (< 32 km) to a SCC. This gap remains unchanged over the first year after an MI except for patients living between 64 and 105 km, where a closing of the gap can be noticed.