Geographic Disparities in Treatment and Clinical Outcomes of Acute Myocardial Infarction in the United States: A Retrospective Cross-Sectional Study

Acute myocardial infarction (AMI) remains a leading cause of hospitalization and mortality in the United States. Percutaneous coronary intervention (PCI) improves outcomes, but contemporary research on nationwide PCI access is scarce. This study investigates geographic, demographic, and socioeconomic determinants of PCI usage and inpatient outcomes among AMI hospitalizations. A retrospective cross-sectional analysis of the National Inpatient Sample (October 2015-December 2021) identified US hospitalizations for AMI. Outcomes including PCI utilization, in-hospital mortality, routine discharge, and postacute transfer, were stratified by region, urban-rural status, and income quartile. Multivariable logistic regression assessed factors associated with PCI use, adjusting for demographics, comorbidities, and hospital characteristics. Among 5,752,863 AMI hospitalizations, 20.2% occurred in rural and 79.8% in urban counties; 36.8% involved PCI (20.1% rural, 79.9% urban). After adjustment, urban hospitals had higher odds of PCI [adjusted odds ratio: 1.15; 95% confidence interval (1.13-1.18); P < 0.001), routine discharge [1.06 (1.04-1.08), P < 0.001], and transfer [1.09 (1.07-1.11), P < 0.001], with lower mortality [0.962 (0.941-0.983), P < 0.001]. Higher-income patients were more likely to undergo PCI [1.10 (1.08-1.12), P < 0.001] and routine discharge [1.06 (1.04-1.08), P < 0.001], and had lower odds of mortality [0.963 (0.941-0.986), P = 0.002] and postacute care transfer [0.957 (0.938-0.976), P < 0.001]. PCI was significantly associated with age, sex, race, insurance status, comorbidity burden, hospital location, and bed size. Notable PCI disparities persist between urban and rural populations, with lower mortality in urban regions. Socioeconomic and demographic factors continue to influence PCI, underscoring inequities in AMI care. These findings highlight the need for quality initiatives to ensure equitable treatment nationwide.