Angioplasty Best for Heart Attack Survival

When emergency clot-dissolvers failed, it upped survival rates, study found

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By Ed Edelson
HealthDay Reporter

WEDNESDAY, Dec. 28, 2005 (HealthDay News) -- Emergency angioplasty to reopen a blocked artery is the best thing to do when clot-dissolving therapy doesn't work for a heart attack, British cardiologists report.

It's a finding of major importance to a large number of Americans who are rushed to a hospital emergency room when they have a heart attack, a U.S. expert said.

"This trial comes in a timely fashion," said Dr. Samin Sharma, director of interventional cardiology at Mount Sinai Medical Center in New York City. The finding is already affecting medical practice in this country because preliminary results were presented at a recent medical meeting, Sharma added, but "a lot of people have been waiting to see the final word in print."

Angioplasty has been the recommended emergency treatment for a heart attack, Sharma said. But many American hospitals lack the ability to do that treatment on an emergency basis; from 50 percent to 60 percent of U.S. patients get clot-dissolving drugs when they arrive at the emergency room, he said.

"What to do in those 40 percent or more of cases has been a matter of intense debate for many years," Sharma said.

The results of the trial designed to settle that debate appear in the Dec. 29 issue of the New England Journal of Medicine.

For the trial, doctors at the University of Leicester used 427 heart attack patients whose arteries were not reopened by clot-dissolving therapy within 90 minutes of the attack.

Some of those patients got another round of clot-dissolving drugs. Others got conservative treatment, essentially watchful waiting, while still more had angioplasty, a procedure in which a catheter is inserted and a balloon at its end is inflated to reopen the artery.

The survival rate was lowest for patients who got more clot-dissolving drugs, 68.7 percent. It was slightly higher, 70.1 percent, for those getting conservative treatment. And it was significantly higher, 84.6 percent, for the angioplasty group.

After six months, the arteries remained clear in 86.2 percent of those who had angioplasty, compared to 77.6 percent of those getting conservative treatment and 74.4 percent of those getting more clot-dissolving drugs.

There was one negative note in the report, a slightly higher incidence of minor bleeding in the angioplasty group, but "there was no major bleeding or bleeding in the brain," Sharma said.

The report fits in with an ongoing drive to have more heart attack patients get angioplasty as their first treatment, said Dr. Sorin Brener, an interventional cardiologist at the Cleveland Clinic.

A number of regional programs designed to have people who suffer heart attacks brought to facilities equipped to do angioplasty have been set up, including one in Cleveland, Brener said.

"There is a lot of attention to the problem, but I don't think we are as good as we should be," he said.

More information

A complete rundown on angioplasty is available from the National Library of Medicine.

SOURCES: Samin Sharma, M.D., director, interventional cardiology, Mount Sinai Medical Center, New York City; Sorin Brener, M.D., interventional cardiologist, Cleveland Clinic; Dec. 29, 2005, New England Journal of Medicine

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