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Transfer Often Helpful for Heart Attack

Study Shows Transfer to Facility for Angioplasty Fights Repeat Heart Attacks Best
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Aug. 20, 2003 -- There is more evidence that treating heart attacks with coronary angioplasty beats out taking clot-busting drugs -- even when it takes more time to get the treatment. The news might make people with heart conditions think twice about where to seek treatment.

Previous studies show that heart attack patients fare better using angioplasty vs. drugs that dissolve blood clots in hospitals equipped with angioplasty facilities.

Angioplasty is a procedure that uses a tiny balloon to open blocked arteries that cause coronary artery disease. This procedure is limited to hospital facilities that have a backup team of surgeons prepare for complications that could result from the angioplasty procedure.

But a new study, published in the latest issue of TheNew England Journal of Medicine, shows that this holds true even when doctors must use precious moments to transfer a patient having a heart attack to a hospital that can perform the procedure. Researchers point out, however, that the transfer must take less than two hours.

For the study, researchers randomly assigned 1,570 patients entering a hospital with a heart attack to be treated with angioplasty or an intravenous clot-busting drug. Of these, more than 1,000 patients had to be transferred to a site that performed the procedure. Researchers analyzed the rates of complications such as death, repeated heart attacks, and if there was a disabling stroke within 30 days.

Lower Rate of Repeat Heart Attack

The results showed that among patients who were transferred to hospitals within a two-hour period for angioplasty, 9% had complications vs. 14% who were transferred for clot-busting drugs.

For the patients that received angioplasty vs. the clot-busting drugs onsite, that rate was similar -- nearly 7% and 12%, respectively.

Researchers say the lowered rate of having another heart attack gave angioplasty treatment a lower overall complications rate (1.6% vs. 6.3% for drug group). But the treatments didn't show a big difference when it came to death rates or strokes.

They conclude that transferring a heart attack patient to a facility that has an angioplasty team is superior to on-site clot-busting drugs if the transfer can be done within two hours.

SOURCE: The New England Journal of Medicine, Aug. 20, 2003.

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