Speedy Angioplasty Is Critical to Heart Attack Patients' Survival
June 13, 2000 -- For heart attack patients who receive the artery-clearing
procedure called angioplasty, an hour can mean the difference between life and
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.