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Studies Clarify Best Practices for Heart Care

People should receive angioplasties to unclog arteries in the first 90 minutes following a heart attack, though they often don't receive the treatment in time, the American Heart Association said at a recent meeting. An expert discusses this and other recommendations.

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      Two major findings presented at an American Heart Association meeting in Chicago this week could make a difference in how heart attack patients are treated.

    Opening clogged arteries by balloon angioplasty is still the recommended response, but only one-third of heart attack victims get them as quickly as they should, within 90 minutes of their arrival at the hospital. And getting an angioplasty more than three days after a heart attack does not reduce the risk of having another one.

    For more, we turn to Dr. Elizabeth Nabel, the director of the National Heart, Lung, and Blood Institute, which is part of the National Institutes of Health.

    Welcome, Dr. Nabel.

    ELIZABETH NABEL, Director, National Heart, Lung and Blood Institute: Good evening.


    Are we saying now that angioplasties, which we have always taken to be the gold standard, that they're being overused?


    Well, let's first remember that angioplasties are a very effective treatment for heart attack victims during the first 12 hours of the heart attack. We know that opening up the blocked artery during the first 12 hours will save lives, and it will improve the functioning of the heart muscle.

    What this new study has taught us is that opening up the blocked artery days, weeks and months later is not that beneficial over and above standard medical treatment.

    The study randomized individuals between angioplasty and stents, plus medical therapy, versus medical therapy alone, and then followed individuals for a standard of four years to see if they developed recurrent heart attacks, heart failure, or died. And what we learned is that the angioplasty and stent did not benefit patients in terms of heart attack, heart failure or death.


    So the stent, which is that little metal mesh opening, which is threaded up through the thigh and into the heart and is supposed to prop open these veins, even if that happens after the fact — you're saying three days after the fact — it seems counterintuitive that that wouldn't keep it from clogging again.


    You're right, Gwen. And cardiologists for many years have thought that having an opened artery would benefit patients, but we never tested it in an objective, randomized clinical trial. And that's what this study did.

    Now, the results were surprising. We didn't anticipate this. We hypothesized that opening the artery would benefit patients, but, lo and behold, the findings are what they are.