People having a heart attack should be given balloon angioplasty without delay once they reach a hospital to reduce their risk of dying, a new study concludes.Balloon angioplasty, or primary percutaneous intervention, is used to open blocked coronary arteries.
For the study, researchers analyzed data on 43,801 heart attack patients treated at U.S. acute-care hospitals. All had undergone balloon angioplasty within 12 hours of a heart attack. The average time between their arrival at the hospital and the procedure was 83 minutes, and 58 percent received balloon angioplasty within the 90-minute target currently recommended.
The overall death rate was 4.6 percent. Those who waited longer for balloon angioplasty, the study found, were more likely to die. The death rate for those treated within 30 minutes was 3 percent, compared with 4.3 percent for those treated 90 minutes after arrival and 10.3 percent among people who waited 270 minutes for treatment.
Women, non-white and older patients were more likely than others to have longer waits for treatment. The study also found that people who waited longer for angioplasty had more co-existing health problems, such as high blood pressure and diabetes.
The findings suggest the need to re-think the current 90-minute target, the researchers said.
“Rather than accepting the 90-minute door-to-balloon time benchmark, our data support calls for an ‘as soon as possible’ standard for patients undergoing primary percutaneous coronary intervention,” they wrote. “Such an approach, using necessary safeguards against inappropriate treatment, offers the potential for notable mortality reduction.”
The study was published online in BMJ.
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A major problem is that cardiac catheterization may only be done at a hospital which also offers cardiac surgery. Occasionally, complications occur, such as the balloon catheter rupturing an artery, causing a very serious internal bleeding which must immediately be repaired surgically, by a cardiac surgeon.
For this reason, catheterizations are only carried out at hospitals with cardiac surgery facilities. Unfortunately, this excluses most smaller hospitals.
Now, the big question for cardiologists to focus on is whether it should be standard practice to only take ‘heart attack’ patients to larger facilities which do offer these services.