Quick Angioplasty Best After Heart Attacks

Canadian study shows better survival when compared to those who got clot-busting treatment

By Ed Edelson
HealthDay Reporter

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WEDNESDAY, June 24 (HealthDay News) -- A new Canadian study adds compelling support for current recommendations that people who first get clot-dissolving treatment for heart attacks should have artery-opening angioplasty as soon as possible afterward.

"This study strengthens the guideline recommendations," said Dr. Warren J. Cantor, an assistant professor of medicine at the University of Toronto and lead author of a report in the June 25 issue of the New England Journal of Medicine. "The original recommendation was based on a limited number of trials. This is the largest trial done to date looking at the strategy of doing angioplasty routinely after fibrinolysis [clot-dissolving therapy]. It confirms that it is a safe approach with no increase in major bleeding, and that patients do better when they undergo angioplasty."

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Immediate angioplasty after a heart attack is best, but many medical centers are not equipped to do the procedure on an emergency basis, Cantor noted. "In most centers in the world, patients receive clot-busting medication," he said. "Many are routinely transferred to a center where they can undergo angioplasty."

The study shows that angioplasty should be done within six hours, Cantor said.

The study included 1,059 people who had major heart attacks and were given clot-dissolving treatment at Canadian medical centers not equipped for angioplasty. Half were assigned to standard treatment, clot-preventing drugs with aspirin and the blood thinner heparin, with angioplasty done when possible. The other half were transferred to centers where angioplasty could be done within six hours.

Nearly 90 percent of those getting standard treatment did have angioplasty, done after an average wait of more than 32 hours. Nearly all those transferred for quick angioplasty had it in less than three hours. After six months, 11 percent of those who had quick angioplasty had a major adverse cardiac event or died, compared to 17.2 percent of those assigned to standard treatment.

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