Floating population as risk factor affected achievement of primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in Guangzhou

Abstract

Background: Although current guidelines recommend that primary percutaneous intervention (PCI) should be performed for ST-elevation myocardial infarction (STEMI), accessibility to this important health care service for severe heart emergency among floating population in Guangzhou remains largely unstudied and poorly understood. This retrospective study explored the variations in the odds of receiving primary PCI for STEMI patients among floating population and residential population in Guangzhou.

Methods: Study data were collected from the First People’s Municipal Hospital of Guangzhou to conduct a cross-sectional study of 1,216 patients with STEMI (code 410 of ICD-9) for the period from 2009 to 2014. Data in this study, including demographic and clinical characteristics, invasive treatment and pre-hospital delay time, was retrieved from electronic medical record system developed in 2005 and maintain a comprehensive electronic record of all patients of hospital. Chi-square test was performed to evaluate the differences in demographic characteristics and coexisting condition among STEMI patients between floating population and residential population. Differences in receipt primary PCI, pre-hospital delay time and door-toballoon time between two population groups were evaluated by a binary logistic regression model. To evaluate the performance odds, I adjusted for age, gender, and coexisting conditions. Data of the study was analysed using the SPSS 21 package software.

Result: Compare to residential population, STEMI patients in floating population were less likely to receive primary PCI ( 20.5% vs 26.3%, P=0.049). On adjusting for sex, age and coexisting conditions, the odds of receipt primary PCI for STEMI patients in floating population was lower than residential population (floating population, OR=0.63, 95% CI=0.45-0.88; residential population, OR=1.0). More pre-hospital delays of STEMI patients undergoing primary PCI were found in floating population, the odds of delay time >6 hours was higher than residential population ( OR=4.27, 95% CI=1.49-12.24). There was no statistical difference in door-to-balloon time >90 minutes between two population groups (OR=1.61, 95% CI=0.60-4.32).

Conclusion: Patients with STEMI in Guangzhou floating population were less likely to receive primary PCI. Policy interventions including government subsidy on severe disease in population, pilot medical insurance schemes, and transferability of insurance payment cross provinces are needed to increase the accessibility to emergency severe health care for STEMI patients in floating population. Additionally, an educational program on early symptoms and rapid response of STEMI should be established to increase the awareness at national level, especially in floating population.