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A study of 590,282 California heart attack hospitalizations found that opening a facility able to perform percutaneous coronary intervention was associated with lower mortality when it brought the service within a 30-minute drive for communities that previously lacked timely access. In areas that already had access, another facility brought small increases in treatment but no significant mortality change.
A study of 590,282 heart attack hospitalizations in California found that patients in communities without a PCI-capable hospital within a 30-minute drive had lower mortality after a new facility opened nearby. In communities that already had timely access, another facility slightly increased treatment use but was not associated with a significant change in survival, according to research led by the University of California, San Francisco and published in JAMA Network Open.
The researchers examined what happened after a hospital able to provide percutaneous coronary intervention (PCI) opened within a 30-minute drive. PCI restores blood flow through blocked arteries and can be used to treat heart attacks. Providing it requires specialized facilities, equipment and staff.
In communities that lacked nearby access before a facility opened, admission to a PCI-capable hospital rose by 53% relative, and the share of patients receiving the procedure increased by 16%. The study reported a 20% decline in 30-day mortality and a 15% decline in one-year mortality in this group. These are relative changes as reported by the study; they do not indicate the absolute number of deaths prevented.
Where PCI was already available within 30 minutes, a new facility was associated with a 2% increase in admission to a PCI-capable hospital and a 3% increase in procedure use. Researchers found no significant mortality change in those communities. The analysis covered hospitalizations from 2011 through 2022.
Where New PCI Capacity May Help Most
The results suggest that the health effect of adding a specialized emergency service may depend on where it is placed, not simply on how many facilities exist. Opening a hospital in an area without timely access was associated with both greater use of PCI and lower mortality; adding another nearby option where the service was already accessible was associated with modest treatment changes but no significant survival improvement.
This distinction matters to communities and decision-makers weighing investments in expensive emergency infrastructure. The researchers said hospital investment decisions may be shaped by expected procedure volume, market demand and financial return, which do not necessarily point to places with the greatest unmet need. The study does not establish that every new facility will produce the same results, but it offers evidence that closing a geographic access gap can be associated with better outcomes.
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Rural Access Was Often Limited
The access gap was pronounced in rural California. Among the 52,756 rural patients in the analysis, 81% lived in places without a PCI-capable facility within a 30-minute drive at the beginning of the study period. That finding describes the study population and its starting access conditions; it does not mean that all rural communities had the same travel times or care options.
The research extends earlier work by the same team on whether opening a PCI facility changed procedure volume. That earlier analysis found PCI procedures rose 7.5% in communities after a facility opened, with a larger increase in places that had lacked timely access. The newer study examined whether added capacity was associated with a change in clinical outcomes. It was conducted by Y.-C. Shen and Renee Y. Hsia and published in JAMA Network Open in 2026.
““Americans tend to think more is better, but where you put these services really matters.””
— Renee Y. Hsia, UCSF professor of emergency medicine and the study’s senior author
Limits of the California Analysis
The reported findings are associations from an observational analysis; the supplied study summary does not establish that opening a facility alone caused the mortality changes. It also does not provide absolute mortality rates, confidence intervals or the number of deaths represented by the relative declines, limiting what can be concluded about the size of the effect in absolute terms.
The available information does not explain how the researchers accounted for other changes that may have occurred as facilities opened, or whether the findings would apply to other states and health systems. It also does not establish that a 30-minute drive is an appropriate access threshold for every patient or circumstance. The study focuses on PCI access and heart attack hospitalizations, not all emergency services or all causes of cardiac death.
Questions for Health Planners
The findings may inform future decisions about where hospitals and policymakers place PCI services, particularly in areas with limited access. The researchers argue that planning should weigh population health benefit alongside procedure demand and investment costs. The study does not announce a policy change or a specific plan to open facilities.
Further research could test whether similar associations appear in other regions and examine how facility openings interact with ambulance transport, referral patterns and other parts of emergency heart attack care. For now, the study’s reported comparison is between California communities that had different levels of nearby PCI access during the 2011–2022 period.
Key Questions
What is PCI?
Percutaneous coronary intervention is a procedure used to restore blood flow through blocked arteries. The study examined access to hospitals equipped to perform it for heart attack patients.
What changed when a PCI facility opened nearby?
In communities that previously lacked a PCI-capable hospital within a 30-minute drive, the study reported increased admission to such hospitals and procedure use, alongside lower 30-day and one-year mortality. These findings are associations, not proof that the opening alone caused the changes.
Did another nearby facility improve survival where PCI was already available?
The study found small increases in PCI-capable hospital admissions and procedure use in those communities, but no significant change in mortality.
How many rural patients lacked timely access at the start?
Of 52,756 rural heart attack patients in the study, 81% lived in places without a PCI-capable facility within a 30-minute drive at the beginning of the study period.
Does this study prove that opening a facility prevents deaths?
No. The study reports associations in California hospitalization data from 2011 to 2022. The results do not by themselves establish that a facility opening caused the mortality changes or that the same pattern would apply everywhere.
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