Clot-Busting Drugs Save Heart Attack Victims

Study finds early therapy effective when time is important

By Ed Edelson
HealthDayNews Reporter

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THURSDAY, Sept. 12 (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.

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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.

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