More Percutaneous Coronary Intervention Doesn’t Always Mean Better Care: New Study Shows Expansion Drives Both Access and Overuse

Published in JAMA Network Open on March 31, a UC San Francisco-led study analyzed more than 650,000 patients undergoing percutaneous coronary intervention (PCI) across California to examine how the opening of new PCI-capable hospitals changes care patterns. The findings suggest that while expansion substantially improves access in underserved communities, it may also drive increased use among lower-risk patients in areas that already have PCI capacity.

“PCI is lifesaving when used appropriately, but expanding capacity has complex effects,” said senior author Renee Y. Hsia, MD, MSc. “In communities without prior access, new PCI centers appear to meet real unmet need. But in areas that already had PCI, expansion may be contributing to more discretionary procedures without clear clinical necessity.”

The research team used statewide all-payer data from 2011 to 2022 to examine changes in procedural volume and patient characteristics before and after new PCI-capable hospitals opened near communities. By comparing communities with and without baseline PCI access, the study provides insight into whether expansion improves equity or contributes to overuse. 

The study found that PCI volume increased significantly after new facilities opened, but the magnitude and clinical implications differed by community context.

Key findings include:

• Community PCI volume increased by 7.5% overall after a new PCI facility opened but increased by nearly 20% in communities that previously lacked PCI access, suggesting the release of pent-up demand. 
• Across both underserved and already-served areas, the share of patients undergoing PCI for stable angina – a condition often managed medically – increased by 6.5% and 4.7%, respectively, raising concerns about potential supply-driven use. 
• In communities that already had PCI access, new openings were associated with increases in the share of both lower-risk patients (those without prior heart attacks or coronary artery bypass grafting) and more complex multivessel procedures, suggesting shifts in clinical decision-making rather than purely improved access. 
• In communities without prior access, the share of patients undergoing single-vessel procedures increased, consistent with treating patients who previously lacked timely care.  

The results highlight a central tension in health system planning: expanding high-cost procedural capacity can simultaneously improve access and increase utilization beyond clinical need.

“These findings show that where new cardiac services open matters as much as whether they open,” Hsia explained. “Strategic expansion into underserved areas can improve equity and outcomes, but duplicating capacity in already saturated markets may increase costs without improving population health.”

The study underscores the importance of aligning hospital service expansion with community needs. Policymakers and regulators may need to consider geographic access, market competition, and procedural appropriateness when approving new high-cost service lines such as PCI.

Future research will examine how PCI expansion affects downstream patient outcomes, including mortality and long-term cardiovascular events, and how regulatory and payment policies can encourage infrastructure growth that improves access without increasing low-value care.

References

Shen YC, Sarkar N, Hsia RY. Community-level procedure volume and patient health profiles following PCI-capable facility openings. JAMA Netw Open. 2026 Mar 2;9(3):e262420. doi: 10.1001/jamanetworkopen.2026.2420. PMID: 41910975.