Which Hospital Is Best for Heart Attack Victims?

Danish study favors major centers for angioplasty

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HealthDay Reporter

(HealthDay is the new name for HealthScout News.)

WEDNESDAY, Aug. 20, 2003 (HealthDayNews) -- People who suffer heart attacks do better if they are sent quickly to major medical centers for artery-opening angioplasty operations, rather than staying in community hospitals where they are given clot-dissolving treatment, a Danish study finds.

Angioplasty is far better at preventing a second heart attack, the researchers say.

So can the results of the latest trial, and others that have given similar results, be applied to the United States, where a majority of heart attack patients take a long time to reach major medical centers that have the ability to do angioplasty?

Some American experts say "yes." The Danish trial, reported in the Aug. 21 New England Journal of Medicine, shows that "now is the time to discard the practice of transporting patients with acute myocardial infarction [heart attack] to the nearest hospital and to transport them preferentially to centers of excellence," says an accompanying editorial by Dr. Alice K. Jacobs of Boston University Medical Center.

Others are not so sure, including the lead author of the report, r. Henning R. Andersen, assistant professor of cardiology at the Aarhus University Hospital in Copenhagen.

For one thing, the medical systems of the two countries are very different, he says.

"In my country, we don't have private hospitals," he says. "Everything is paid by the government. In the United States, a hospital may be reluctant to transfer a patient because of the income from that patient."

And there are other differences, adds Dr. John G. Canto, the director of the coronary care unit and chest pain center at the University of Alabama in Birmingham. One is in organization, he says.

"Denmark is amazing," Canto says. "The time when patients present for the initial hospitalization to when they get the artery open is shorter than when patients present here. They can open an artery much faster than we in the United States can do."

And geography is another factor, Canto says. Jacobs works in Boston, where a high-skilled medical center is usually only minutes away. The same is true of Birmingham, where "we have 16 hospitals, and 12 can do that intervention," he says. "But if you are in a rural part of Alabama, I don't know whether the two hours you would have to drive would be worth it."

Angioplasty is clearly the better treatment, Canto adds. "But if the question is whether these results can be extrapolated to the United States, my answer is that we don't know."

The benefits of quick angioplasty might not be overwhelming, Cano says. In the Danish study, the death rate for the patients who had angioplasty and those who had clot-dissolving treatment was not very different: 6.6 percent for angioplasty, 7.8 percent for clot-dissolving treatment.

The big gain was in preventing further heart attacks. Only 1.6 percent of the angioplasty patients had a second heart attack, compared to 6.3 percent of those getting clot-dissolving treatment.

"Ultimately, what matters is death," Canto says.

His advice: When someone appears to be having a heart attack, take him to the nearest hospital, whether or not it is equipped to do angioplasty.

"Once you get the patient to a hospital, it can be decided whether he should be transported to a medical center where they do primary angioplasty," Canto says.

More information

For a guide to the symptoms of a heart attack, turn to the American Heart Association, which also has a page explaining angioplasty.

SOURCES: Henning R. Andersen, assistant professor of cardiology, Aarhus University Hospital, Copenhagen, Denmark; John G. Canto, assistant professor of medicine, University of Alabama, Birmingham; Aug. 21, 2003, New England Journal of Medicine

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