Angioplasty Works Best When Hospitals Use It Most

Making the procedure first-line therapy makes a difference, study finds

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By Ed Edelson
HealthDay Reporter

MONDAY, Jan. 16, 2006 (HealthDay News) -- Studies have shown that the artery-opening procedure called angioplasty is the best emergency treatment for a heart attack, rather than clot-dissolving drug therapy.

And a new study shows that angioplasty is most effective when performed in hospitals that make it the first-line treatment for heart attacks, rather than at centers where it is not the leading form of heart attack care.

"What is interesting about this finding is that whether a hospital specialized in the approach turned out to be more important than the volume of procedures," said study leader Dr. Harlan M. Krumholz, a professor of medicine at Yale University. "The usual article says that if you do something more, you do it better. We showed that what mattered was whether you committed to a specific strategy."

During angioplasty, surgeons first thread a tiny balloon-tipped catheter into the blocked vessel. They then restore blood flow by inflating the balloon, which flattens built-up plaque against the vessel wall.

In their study, researchers at the University of Michigan and Yale University pored over data on more than 37,000 people given emergency treatment for heart attacks at 463 American hospitals.

Their analysis showed that those treated in hospitals that wavered between angioplasty and drug therapy were one-third more likely to die in the hospital.

The higher death rate was associated with a longer wait for treatment -- an average of 20 vital minutes -- and a higher likelihood that treatment would not begin in the recommended 90-minute window after the attack, according to a report published in the Jan. 17 issue of Circulation.

Committing to angioplasty as first-line therapy leads to faster treatment, perhaps the most critical element for a heart attack patient, said lead researcher Dr. Brahmajee K. Nallamothu, an assistant professor of medicine at the University of Michigan.

"If you come to a hospital that has angioplasty as its default treatment, you go straight to the catheter lab," he said. "That allows a lot of things to happen quickly."

The finding shouldn't change the action of anyone having a heart attack, or people who think that someone they love may be having a heart attack, Nallamothu said. That advice is the same as ever: Call 911 and get emergency medical help as quickly as possible.

But there are policy implications for hospitals trying to decide what services to provide, Krumholz said. "It seems best to decide on a single approach to the care of patients with heart attacks and stick to it," he noted.

Hospitals not equipped for round-the-clock angioplasty might work on optimizing their clot-dissolving therapy, or determine better ways to institute emergency angioplasty measures, the report said.

"This is pretty clear evidence that if you are a hospital trying to decide what to do and you commit to angioplasty, do it completely," Krumholz said. "If you can't commit to angioplasty, look carefully at your processes and the way you approach your decision, getting clarity in your system and setting standards for what to do at, say, three [o'clock] in the morning."

The study makes a subtle change in the finding that angioplasty patients do better in hospitals that do a high volume of the procedures, Nallamothu said.

"Volume is a measure of quality," he said. "When people who do angioplasty really well, the volume of procedures they do goes up. Good outcome drives volume."

More information

For more on angioplasty head to the National Library of Medicine.

SOURCES: Harlan M. Krumholz, M.D., professor, medicine, Yale University, New Haven, Conn.; Brahmajee K. Nallamothu, M.D., assistant professor, medicine, University of Michigan, Ann Arbor; Jan. 17, 2006 Circulation

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