title: Access to myocardial revascularization procedures: closing the gap with time?
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 > or = 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 (> or = 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Family Medicine Department, Faculty of Medicine, Université de Sherbrooke, Sherbrooke (QC), J1H 5N4, Canada. alain.vanasse@usherbrooke.ca
authors.forename: Alain
authors.initials: A
authors.lastname: Vanasse
authors.forename: Théophile
authors.initials: T
authors.lastname: Niyonsenga
authors.forename: Josiane
authors.initials: J
authors.lastname: Courteau
authors.forename: Abbas
authors.initials: A
authors.lastname: Hemiari
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D002300:Cardiac Care Facilities / Q000600:supply & distribution*; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D005260:Female; D005843:Geography; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000601:surgery*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D010351:Patient Discharge; D011792:Quebec / Q000453:epidemiology; D012042:Registries; D013997:Time Factors