Study shows surgery best when drugs fail to fix heart
By Gene Emery
BOSTON (Reuters) – When clot-busting drugs fail to stop a
heart attack, surgery to reopen a clogged artery is the most
effective way to treat a patient, cutting the risk of death in
half, a new study shows.
The study, published in this week’s New England Journal of
Medicine, could revolutionize the way smaller U.S. hospitals
treat heart attack patients, forcing them to set up
arrangements with larger hospitals capable of performing the
surgery, known as angioplasty.
The data, funded by the British Heart Foundation and
conducted at 35 British medical centers, also found that
angioplasty, where a tube is threaded into the heart so a
balloon can reopen the clogged area, reduces by half the risk
of a stroke, heart failure, or later heart attack.
Angioplasty is helpful even when factoring in the extra
time it may take to move a patient to a hospital where the
procedure can be performed, the study shows.
“It’s certainly changed our practice, and rescue
angioplasty is the standard of care now in the UK,” chief
author Anthony Gershlick told Reuters.
Gershlick, who works at the University of Leicester, said
many U.S. hospitals do nothing if an electrocardiogram shows
that clot-busting drugs have not worked. He noted that in 30 to
40 percent the drugs are ineffective.
The new study of 427 volunteers found that giving more
clot-busting drugs offered virtually no benefit over
conventional treatment with the blood thinner heparin. “It’s
almost like doing nothing, Gershlick said.
About 30 percent in both groups died, had another heart
attack, suffered a stroke or developed severe heart failure.
But among those who had the option for angioplasty when the
clot-dissolving drugs failed, the was rate was 15 percent, even
though many patients had to be transferred to another hospital
for the surgery. That transfer usually delayed the surgery by
an average of 84 minutes, the study shows.
Six months after the initial heart attack, the Gershlick
team found that 6 percent of those who had received the surgery
had died while nearly 13 percent of the patients who had been
treated only with drugs had died.
The likelihood of a second heart attack was also far lower
for the angioplasty group — 2.1 percent compared to 8.5
percent among those who received conventional care and 10.6
percent with the second dose of clot-busters.
One side effect of the drugs is bleeding. Five patients
died of bleeding problems in the group that received a second
dose of clot-busting drugs; three died with conventional
treatment; and there were no bleeding-related deaths in the
angioplasty group.
Gershlick said it was understandable that community
hospitals were not pushing for angioplasty if clot-busters
failed. Until now, there had been little evidence to support a
backup treatment, except for an old study from the 1990s
suggesting that a second dose of the drug might help. But that
research used an early, less-effective clot-busting drug.
When clot-dissolving drugs fail, “you need to call the
ambulance, get the cath lab team in, and do an angioplasty,”
Gershlick said.