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.
"If it's the middle of the night and the [cardiac catheterization] lab team can't be mobilized, drug therapy may be a better option," former American Heart Association (AHA) president Sidney Smith, MD, tells WebMD. "As good as angioplasty may be, this study shows that if there is a delay in excess of two hours, you are not going to see an advantage to this therapy." Smith, a professor of medicine at the University of North Carolina, reviewed this study for WebMD.
The study's findings support revised guidelines issued last year by the American College of Cardiology (ACC) and the AHA, calling for angioplasties to be performed within 90 minutes of hospital arrival, give or take 30 minutes.
Smith, who now chairs the ACC/AHA committee that issued the revised guidelines, says this study will help get out the message that timing is critical for angioplasty.
"These findings fall right in line with the committee's recommendations," he says. "They offer more evidence of the need for physicians and health care systems to monitor door-to-balloon times and work to reduce them."
- Angioplasty is a procedure that uses a balloon to widen the narrowed or blocked artery of a heart disease patient.
- A new study shows that heart attack patients who have angioplasty two and a half hours after reaching the hospital are twice as likely to die as those who receive it within the first hour.
- Timing is critical for the angioplasty procedure, and if it can't be performed quickly, then an alternative treatment with clot-busting drugs may be appropriate, one expert says.