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Speedy Angioplasty Is Critical to Heart Attack Patients' Survival

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WebMD Health News

June 13, 2000 -- For heart attack patients who receive the artery-clearing procedure called angioplasty, an hour can mean the difference between life and death.

Patients who wait two and a half hours to undergo angioplasty after reaching the hospital are twice as likely to die as those who are treated within an hour, a large study finds. A more startling finding is that less than half of heart attack patients are treated within the two-hour time frame that is critical to reducing the chance of death.

"This is a very, very important study, which indicates that the quality of care in many American hospitals is not as good as it should be," cardiologist Michael S. Lauer, MD, tells WebMD. "Between 250,000 and 300,000 people who have heart attacks each year are eligible for this type of therapy. If we were to reduce [death rates] just 1 to 2% by delivering angioplasty faster, we're talking about thousands of lives." Lauer was not a member of the study team, but he wrote an editorial accompanying the study in the Journal of the American Medical Association.

Angioplasty involves inserting a balloon-tipped tube, or catheter, into a narrow or blocked artery in an attempt to open it. By inflating and deflating the balloon several times, physicians usually are able to widen the artery.

Researchers at Boston's Brigham and Women's Hospital evaluated the results of angioplasty on more than 27,000 patients treated for heart attacks at 661 hospitals around the country from 1994 to 1998.

The researchers found that the median time between arriving at the hospital and receiving angioplasty -- known as the "door-to-balloon time" -- was an hour and 56 minutes. Only 8% of the patients had door-to-balloon times of an hour or less. These patients had a death rate of 4.2%, compared to 6.1% for the group overall, and 8.5% for patients who had the procedure two and a half to three hours after arriving at the hospital.

"We've known for a long time that the faster you get the artery open, the better," study author Christopher P. Cannon, MD, tells WebMD. "But this is really the first time this has been confirmed in a large group of patients. We now have the data to conclusively show that time is critical. This tells hospitals that if they are going to do this procedure, it needs to be done within this two-hour window."

If logistical problems make performing angioplasty within two hours impossible, Cannon and colleagues suggest that so-called "clot-busting" drugs, also known as thrombolytics, are a better treatment option. Logistical problems can include inadequate hospital facilities or a hospital arrival late at night, when teams that perform catheterization are unavailable.

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