Heart attack treated with speedy angioplasty lowers death

People who have had a common kind of heart attack should get artery-clearing angioplasty within six hours after taking clot-busting drugs to prevent more damage, a study found.

After one month, 17 percent of those who didn't immediately have the angioplasty experienced a second attack, loss of blood, heart failure, shock or death, according to the study, published in the New England Journal of Medicine. Only 11 percent of patients who had early angioplasty experienced those complications in the same time period.

Most hospitals don't have the resources to perform angioplasty, in which a balloon-tipped catheter is threaded into a clogged artery to restore blood flow to the heart, so they rely on clot-busting drugs, Freek Verheught, an Amsterdam cardiologist, wrote in a related editorial. The study is the largest to evaluate how best to treat patients after clearing blockages with drugs, said Warren Cantor, the lead author.

"The general recommendations up until now have been to monitor the patient for an hour or two, and transfer only those for whom the clot-busting fails," said Cantor, medical director of the interventional invasive program at Southlake Regional Health Center in Newmarket, Ontario. "And we saw there's no benefit to waiting. Patients should be transported and routinely undergo these procedures."

Prescribing clot drugs, such as Bristol-Myers Squibb Co.'s Plavix and the generic heparin, is the most common strategy for restoring blood to the heart, Verheught wrote.

Patients who have a prolonged period of blocked blood supply to the heart can have damage to cardiac muscle, changing the reading on an electrocardiogram, according to the Cleveland Clinic's Web site. This type of heart attack, called an ST- segment elevation myocardial infarction, kills or damages tissue around the clot. Cantor studied patients with this type of attack.

The strategy of transferring hospital patients to get early angioplasty, dubbed "drip and ship" by doctors, has already been incorporated in the region around Cantor's hospital, he said. Patients who report to hospitals that are unequipped to perform angioplasty are routinely sent to his hospital after clot-busting, Cantor said.