Surgery Soon After Heart Attack May Be Best
More Aggressive Approach May Be Merited for Treating Heart Attacks
Sept. 17, 2004 -- A long wait may not be needed after a heart attack before heading to the operating room to repair the damage, according to a new European study.
Spanish researchers found aggressively treating heart attack victims with a combination of clot-busting drugs to clear clogged arteries and heart surgery to restore blood flow to damaged heart tissue within 24 hours after their attack was safe and more effective than the more conservative approach currently recommended.
Patients who received the aggressive approach were 66% less likely to suffer a repeat heart attack, require more heart surgery, or die within a year after their heart attack than those who were not immediately treated with surgery.
Researchers say the current recommendations that call for a period of "watchful waiting" to reduce the risk of bleeding problems after the use of clot-busting drugs were based on studies that didn't include modern anticlotting drugs or surgical methods involving angioplasty and stents.
In an angioplasty, surgeons insert a long, slender tube called a catheter through an incision in the groin and guide it into the heart to widen narrowed arteries. A balloon at the tip of the catheter is inflated to open clogged arteries. Stents are mesh-like structures that are inserted during angioplasty to help keep the blood vessel open and improve blood flow.
Because of limited access for angioplasty, transportation to a center, which performs the procedure, can result in delays in the surgical treatment. Clot-busting medications offer immediate treatment for people who have heart attacks and are more widely available.
Experts say that although the combined approach within 24 hours appears effective in the short term, more study is needed on the long-term risks and benefits before changing the current recommendations.
Aggressive Treatment vs. Watchful Waiting
In the study, published in the Sept. 18 issue of The Lancet, researchers compared the safety and effectiveness of the two approaches in 500 people from Spain and Portugal who had a heart attack in 2000 and 2001.
The patients were assigned to receive either aggressive treatment with anticlotting drugs followed by heart surgery within 24 after the start of the drug therapy, or the conservative approach. The conservative approach involved using anticlotting drugs and subsequent heart surgery only if dictated by the patient's symptoms, such as additional chest pain.
In the aggressive-treatment group, patients received clot busters, and then six to 24 hours later had surgery. Angioplasty with stenting was done in 80% of the patients to clear clogged arteries.
Twenty-one percent of the patients in the conservative group subsequently had to have heart surgery due to further chest pain.
Thirty days after treatment, both groups had similar rates of complications. But one year later, patients who received the more aggressive treatment had a lower combined rate of repeat heart attacks, additional heart surgery, and death than the other group (9% vs. 21%).
The aggressively treated group also spent less time in the hospital, and there were no differences in bleeding or other heart-related complications between the two groups.