Angioplasty 1st After Heart Attack

Sumiko Taira, 91, in Ogimi, Okinawa.
Daniel Sieberg
Robert Wood Johnson University Hospital now gives patients having a heart attack artery-clearing angioplasty initially, rather than clot-busting drugs, under a new program aimed at saving more lives.

The New Brunswick hospital, one of New Jersey's best teaching hospitals, adopted the strategy because extensive research shows using angioplasty first to quickly unblock arteries after a heart attack saves more patients and gives them a better life afterward.

The program, which required scheduling teams of specialists to keep the hospital's cardiac catheterization lab open 24 hours a day, was begun earlier this year. The hospital announced it Tuesday, after ensuring it could maintain that difficult schedule without any problems, said Dr. John Kostis, chief of medical services at Robert Wood Johnson.

He said initial patient results have been good, and the hospital usually has been able to do the procedure within 60 minutes of a heart attack patient reaching the emergency department, meeting guidelines of heart specialty groups.

"The earlier we do it, the smaller the heart attack becomes" and the less permanent heart damage there is, Kostis said. "Time is muscle."

He said research indicates patients getting angioplasty promptly have lower death rates, are more likely to survive a later heart attack, and are less likely to develop congestive heart failure from the muscle damage gradually reducing how much blood the heart pumps.

"Internationally and nationally, this is how it is moving, the whole field," said Kostis, who is chairman of the department of medicine at Robert Wood Johnson Medical School nearby.

Dr. Gray Ellrodt, chairman of an American Heart Association committee urging hospitals to quickly give heart attack patients key, proven treatments, said Robert Wood Johnson University Hospital is in a minority of hospitals with such a program. He said the strategy started in big teaching hospitals, then spread to community hospitals.

"I personally feel that this is the wave of the future," Ellrodt said.

Still, most community hospitals can't provide the special equipment and teams of cardiologists, heart surgeons, nurses and others with special training round-the-clock, he said.

In angioplasty, a patient first has dye injected into the heart's arteries, and a moving X-ray pinpoints any clots. Then, a surgeon threads a catheter up to the clot, inflates a balloon on the catheter tip to flatten plaque blocking the artery and, usually, places a scaffold-like mesh stent there to prop it open.

Ellrodt said while there is still a bit of debate about whether starting with angioplasty or drugs saves more lives, it's clear patients who start with angioplasty have fewer complications: stroke, a second heart attack or the need for a second heart procedure.

Kostis and Ellrodt both stressed that it is crucial for heart attack patients to go to a hospital immediately after symptoms begin because delaying treatment can considerably increase chances of death or long-term disability. Heart attack symptoms include chest pain that may radiate to other parts of the body, shortness of breath, weakness, sweating, nausea and lightheadedness.

Dr. Harlan Krumholz, professor of cardiology at Yale School of Medicine, said the heart attack patients should be taken to the nearest hospital, rather than shop around for an all-angioplasty one. He noted that guidelines at last month from top cardiology groups state that angioplasty is better if it can be given just as quickly as clot-busting, or thrombolytic, drugs.

"Too many people in this country aren't being treated with either approach," he added, "or are being treated too late."

Kostis said his hospital now performs nearly 3,300 angioplasties annually.

It is one of 17 New Jersey hospitals licensed to do cardiac surgery, according to the state Department of Health and Senior Services. Another 12 hospitals may do angioplasty alone.

No figures were available on how many U.S. hospitals use such an "angioplasty first" strategy.

However, heart attack remains the top cause of death for Americans, killing more than 450,000 per year. About 1.1 million Americans have their first heart attack each year, and another 450,000 suffer a recovering heart attack, according to the heart association.

Just over 1 million angioplasties were performed in 2001, about double the number of heart bypass surgeries, according to the heart association's latest data.

By Linda A. Johnson