Help for High-Risk Heart Attacks

June 24, 2009 -- Patients who have a heart attack and receive clot-busting drugs do better if they are transferred as soon as possible to a hospital that can perform angioplasty, a procedure to open blocked arteries, according to a new study.

That treatment approach works better than giving clot-busting drugs and then waiting to see if the medications work, transferring them only if the clot-busting drugs fail, says Shaun Goodman, MD, ?study co-author and co-chair of the Canadian Heart Research Center, Toronto.

Performing angioplasty right after a heart attack "is a great procedure, if it can be done," he says. But in the U.S. and Canada, as well as other locales, angioplasty capabilities aren't available on site at many hospitals. "In the U.S., less than 25% of acute care hospitals have on-site angioplasty," Goodman says. So Goodman's team wanted to see if the timing of angioplasty after clot-busting drugs might improve outcomes. The study is published in The New England Journal of Medicine.

Angioplasty After Heart Attack: Study Details

For the study, Goodman's team compared two angioplasty approaches in heart attack patients initially treated at a facility that does not have angioplasty capabilities:

• Standard treatment, in which clot-busting drugs are given and the patient is transferred later to a facility with angioplasty capabilities only if the clot-busters don't work.
• Routine early angioplasty treatment, in which clot-busting drugs are given and the patient is transferred within six hours to another facility for angioplasty.

They randomly assigned 1,059 patients who went to facilities without angioplasty capability between July 2004 and December 2007 to the two treatment approaches. All had a type of heart attack known as an ST-elevation myocardial infarction (STEMI), a kind of heart attack that occurs when a coronary artery is suddenly and totally blocked. ST elevation refers to a specific finding on an electrocardiogram

"It's the sickest group of patients who come to the hospital," Goodman tells WebMD. STEMIs make up a minority of the heart attacks that occur, he says, but "everyone jumps on them. They have the highest risk of dying early on. Even though they are the minority of all [heart attack] patients, this is a run, don't walk situation" to try to save them, Goodman says.

During angioplasty (also known as PCI or percutaneous coronary intervention), a balloon can be inflated to reopen the artery and restore blood flow. A wire mesh tube known as a stent can be placed inside to prevent the blockage from happening again.