THURSDAY, Sept. 12, 2002 (HealthDayNews) -- Giving on-the-spot clot-dissolving treatment to heart attack patients is as effective in saving lives as waiting to give artery-opening angioplasty in the hospital, a French study finds.
It's a study that adds a new element, time, to an ongoing discussion of the best emergency treatment for a heart attack. Several American studies have found that angioplasty -- using a balloon to open a blocked heart artery -- is better than giving a drug to dissolve the clot blocking that artery. But in those studies, clot-dissolving treatment didn't begin until the patient got to the hospital.
Now cardiologists at University Hospital in Lyon, France, report almost identical survival rates in a trial in which some patients got clot-dissolving therapy even before they got to the hospital, while others waited an hour longer and got angioplasty.
The results aren't as clear-cut as could be desired, says Dr. Eric Bonnefoy, a senior physician in the university's coronary care unit and lead author of a study appearing in the Sept. 14 issue of The Lancet. The study didn't enroll as many patients as planned, because money ran out, and 25 percent of the patients who got clot-dissolving therapy ended up undergoing "rescue angioplasty" when it was suspected the initial treatment had failed.
Even so, the death rate for patients who got the early clot-dissolver treatment was 3.8 percent, compared to 4.8 percent for those who waited for angioplasty. The overall incidence of adverse effects, such as a second heart attack, was 8.2 percent for the clot-dissolving group vs. 6.2 percent for the angioplasty group, a difference that is not statistically significant.
The French medical system, which includes doctors in the emergency response team, makes early clot-dissolving treatment "already standard therapy," Bonnefoy. It's not possible just now in the United States, for several reasons, American cardiologists say.
"It's fantastic and I wish we could do it," says Dr. Donald W. LaVan, clinical associate professor of medicine at the University of Pennsylvania and a spokesman for the American Heart Association. "Unfortunately, we have problems with trial lawyers. It carries a certain risk, and someone will complain about it possibly causing harm. But most important, licensing requirements don't permit folks to start it. They [the French} had the luxury of having doctors on board. I wish we could do that."
There have been U.S. trials in which clot-dissolving treatment was administered to heart attack patients before they got to the hospital, says Dr. Judith S. Hochman, director of the cardiac care unit at St Luke's-Roosevelt Hospital in New York. In those trials, emergency technicians transmitted real-time medical data to hospital-based doctors, who could order the treatment. Those trials have not led to general use.
"This reopens the discussion about which is superior, primary angioplasty with inherent delays or very early, pre-hospital fibrinolysis [clot-dissolving treatment]," Hochman says. "The answer may be that if treatment is started very early, fibrinolysis is best, but if the patient is further along, it is best to go to the catheter laboratory for angioplasty."
The French results add more support to the belief that when a heart attack occurs, "time is muscle and the earlier you open the artery the better," Hochman says. As to the method of opening the artery, "we ought to be looking more at early fibrinolysis," she says.
What To Do
Early recognition of a heart attack is essential, and you can learn about the warning signs and symptoms and what should be done from the American Heart Association, which also has a page on heart attack treatments.
