Regional versus metropolitan cardiovascular outcomes in patients with coronary artery disease managed with percutaneous coronary intervention.

Abstract

Background: Coronary artery disease (CAD) affects regional and remote Australians disproportionately. However, there have been no studies that assess the influence of treatment location on percutaneous coronary intervention (PCI) outcomes in an Australian setting. Our study aims to bridge this knowledge gap by comparing PCI outcomes between regional and metropolitan centres in Victoria. Methods/Results: We performed a prospective observational study utilising data from the Victorian Cardiac Outcome Registry (VCOR). 80,635 patients who underwent PCI over the study period (2014–2020) were included. Patients were divided into three groups: those from and treated in metropolitan Victoria (Group A), those from regional Victoria and transferred for treatment in metropolitan Victoria (Group B), and those from and treated in regional Victoria (Group C). Patients who were treated regionally were more likely to present with ST elevation myocardial infarction (Group A: 21% vs Group C: 26%, p<0.001) and were more likely to have complex ACC/AHA B2/C lesions (Group A: 58% vs Group C: 71%, p<0.001). At 1 year, patients from regional Victoria treated in regional centres had lower mortality than patients treated in metropolitan centres (HR=0.86 CI: 0.78–0.96, p=0.006). Rate of MACE at 30 days was similar between regional and metropolitan centres (Group A: 4.1% vs Group C: 3.9%, p=0.65). Conclusion: Regional PCI centres have similar 30-day outcomes and lower 1-year mortality rates than larger metropolitan tertiary centres. Based on these findings, we recommend further development and expansion of regional PCI programs to achieve high quality and equitable CAD care for all Australians.