Heart Attack Patients May Have Other Ticking Time Bombs
Sept. 27, 2000 -- Many people who survive heart attacks may not be out of the woods, even if they received appropriate treatment for the diseased blood vessel that triggered the event. A new study shows that a large number of these people may have something far more sinister brewing -- other blood vessels that are prone to triggering future heart attacks.
The researchers of a new study suggest that these other damaged vessels need to be identified and treated appropriately.
There is more than one way to have a heart attack, but all occur because of reduced blood flow to the heart. The most common occurs when unstable plaque buildup on the vessel wall ruptures and causes a clot to form, blocking blood flow. "Until recently, it was thought that this rupturing was a local incident occurring in one discrete area," study author James A. Goldstein, MD, tells WebMD. "Our observation demonstrates that many patients who have heart attacks have more than one [of these unstable plaques]."
Goldstein and colleagues at William Beaumont Hospital in Royal Oak, Mich., analyzed tests from over 250 heart attack patients treated at the hospital in an effort to identify whether these patients had single or multiple unstable plaques.
The researchers found that 100 of the patients -- just under 40% -- had other unstable plaques that were not involved in their heart attacks.
In the year following their heart attacks, 19% of patients with more than one unstable plaque had periodic chest pain or another heart attack, compared to just under 3% of those with only one unstable plaque.
Repeat procedures were performed within a year in just under one in three of patients with multiple unstable plaques, compared to roughly one in 10 patients with just one unstable plaque.
"This research shows that it is important for [heart specialists] to focus on those other arteries in patients who have had heart attacks," Goldstein says. He adds that if the people with dangerous plaques can be spotted, they could perhaps be followed more closely or treated more aggressively.
The observations confirm the findings of smaller studies and exams of heart patients at autopsy, but they may not have much relevance for patients, says Valentin Fuster, MD, director of the cardiovascular institute at New York City's Mount Sinai Medical Center. That is because it is very hard to spot such problems, he says.
From looking at autopsies, patients who died of heart disease "were likely to have had more than one plaque that has ruptured," Fuster tells WebMD. "What the autopsy studies don't tell you is how many patients with these multiple ruptures live, and that is where this study is valuable."
Fuster and colleagues are conducting studies to determine whether MRI scans can be a useful tool for identifying unstable plaques prior to heart attacks.
"With this technique, we hope to identify the composition of the plaque so that we can predict which plaques are vulnerable to rupture and which plaques are not," he says.