Surgery Soon After Heart Attack May Be Best
More Aggressive Approach May Be Merited for Treating Heart Attacks
Aggressive Treatment vs. Watchful Waiting continued...
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.
Quick, but Cautious Approach Needed
In an editorial that accompanies the study, Freek Verheugt of University Medical Center in Nijmengen, Netherlands, says this is the first large, well-designed study to look at the safety effectiveness of using angioplasty with stenting in combination with modern anticlotting drugs after a heart attack within an average of about 17 hours after start of treatment.
Although these results show that this aggressive approach is more effective in the short term than a more conservative approach, Verheugt says more information is needed about the long-term risks of this strategy. A similar German study that treated a similar group of patients with this approach three to four weeks after their heart attack showed an even lower risk of death after one year.
Taken together, Verheugt says these studies show that, "a routine but deferred strategy might be more helpful in reducing long-term mortality than an immediate approach."