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    Getting Aggressive With Impending Heart Attacks


    Cannon, a cardiologist at Boston's Brigham and Women's Hospital, led a multicenter trial that compared the use of the new clot-prevention drug aggrastat and routine catheterization within 4-48 hours to a more conservative approach that called for the use of the clot-preventing drug alone unless there was urgent need for catheterization. After six months, the patients at highest risk of having a severe heart attack were significantly less likely to die or have that heart attack if they got the more aggressive treatment.

    A problem with the new approach is that not all patients live close to state-of-the-art medical facilities that can provide catheterization. However, Cannon notes that the 48-hour treatment window makes it possible to transport the vast majority of patients to appropriate medical centers.

    William E. Boden, MD, director of cardiology at Hartford Hospital and professor of medicine at the University of Connecticut wrote an editorial noting that this and other studies supporting the use of the new medications will change the practice of medicine. Breaking with the usual policy of the Journal, the editorial contained a chart outlining new guidelines -- which are likely to be made official this year -- for the treatment of such acute coronary syndromes.

    "I think the bottom line is this: if you have prolonged chest discomfort, seek medical attention immediately," Boden tells WebMD. "Go to the hospital to be appropriately screened to see if you are a candidate for one of these procedures."

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