NEW YORK,(Reuters Health) -- Going against conventional wisdom, a
research team reports that combining two widely used treatments for heart attack
may be the best course of action for some patients.
For the past decade, physicians have believed they must choose between
clot-dissolving drugs and invasive procedures such as angioplasty to restore
blood flow to the heart after heart attack, Dr. Allan M. Ross told Reuters
Health.
Ross, a cardiologist at George Washington University in Washington, DC,
led a study of 606 heart attack patients that examined the combination of drug
therapy and angioplasty, a procedure in which a catheter is snaked into a
blocked artery to reopen it. The findings are published in the December issue of
the Journal of the American College of Cardiology.
Both approaches to treating a heart attack have pros and cons: drug
therapy, or thrombolysis, is universally available and can be given to patients
immediately, but it is unsuccessful in a substantial number of cases.
Angioplasty is more effective in restoring blood flow to the heart, but it
is not available everywhere, and patients may spend several precious hours
waiting to have the procedure. But combining the treatments -- giving the drugs
during the delay while waiting for angioplasty -- has been thought to heighten
patients' risk for bleeding during the surgery.
Ross and his colleagues treated all of the study patients first with
aspirin and another drug called heparin. Some patients then received
clot-busting drugs, while the others did not. Next, all received diagnostic
tests to see whether angioplasty was necessary. The researchers found that by
the time these tests were given, 61% of the drug-treated patients had reopened
arteries, compared with 34% of patients who had not received the drugs.
And, among drug-treated patients who went on to angioplasty, there was no
increased risk for complications. Earlier research has suggested that
thrombolysis before angioplasty carries the risk for bleeding and stroke. But,
Ross noted, this study involved lower drug doses and improved angioplasty
techniques.
Because time to treatment is key in lessening patients' heart damage, Ross
said that his team's combined approach may be the best treatment for patients
who need angioplasty but cannot get it within 60 to 75 minutes. In the United
States, he noted, the average wait for angioplasty is 1 to 3 hours.
Larger trials are needed to verify the safety and efficacy of the
two-prong treatment, according to Drs. Ellen C. Keeley and W. Douglas Weaver, of
the Henry Ford Health System in Detroit, Michigan. However, since most heart
attack complications occur in the first few hours, it may be best that all
high-risk patients are treated immediately with drugs while waiting for
angioplasty, Keeley and Weaver write in an accompanying editorial.
