Emergency Angioplasty Could Save Heart Attack Victims

Patients who have an acute myocardial infarction (MI) can benefit from being transferred directly after having received thrombolytics to a hospital where angioplasty can be immediately performed, according to a new study.

Researchers of the Royal Brompton & Harefield National Health Service (NHS) Trust (RBHT; UK) and others in Italy, Poland, and France, examined patients from various networks of community hospitals referred to a larger hospital for a direct percutaneous coronary intervention (PCI) following an acute MI. Patients were randomized with telephone allocation at the time of admission with all adverse events blindly reviewed by an independent committee for adjudication, and all electrocardiogram (ECG) and angiograms analyzed by an independent core laboratory unaware of the treatment received. The interval between administration of the thrombolytic drug and angioplasty was greater than 120 minutes in more than half of the patients, who were therefore not considered candidates for primary angioplasty under the current guidelines--which require an interval of less than 90 minutes between first qualified medical contact and direct angioplasty.

The results showed that patients who are transferred and receive angioplasty immediately after thrombolytics were much more likely to be free from adverse events such as death, a new MI, a new acute episode of chest pain and ECG changes requiring urgent angioplasty (refractory ischemia). This advantage was present despite the fact that all the patients (36% of the entire conservative group) randomized to the group of more conservative treatment (no immediate transfer) were also promptly referred during the first hours post treatment if there was no evidence in their ECG/clinical status that the thrombolytic drugs had open the occluded artery. The study was presented at the European Society of Cardiology annual congress, held during September 2007 in Vienna (Austria).

"The current fear to give thrombolytics before angioplasty is challenged by the low incidence of bleeding observed in this trial,” concluded lead author professor of cardiology Carlo Di Mario, M.D., Ph.D., of the RBHT. "We believe the results will also lead to a more liberal use of a strategy of facilitated angioplasty (i.e., the use of thrombolytics before angioplasty) when there is no certainty that the angioplasty can be swiftly performed within 90 minutes.”


Related Links:
Royal Brompton & Harefield NHS Trust