Heart attack patients may be better off with balloon angioplasty to open blocked blood vessels than with clot-busting drugs, even if their hospital lacks a cardiac surgery program, according to a Johns Hopkins-led study.
The Atlantic Cardiovascular Patient Outcomes Research Trial (C-PORT) looked at 451 heart attack patients admitted to 11 hospitals in Maryland and Massachusetts. The hospitals were given temporary waivers for this study to perform angioplasty even though they had no cardiac surgery capability. In most states, angioplasty may only be performed at hospitals with cardiac surgery programs in the event of complications that require more invasive treatment. Patients were assigned randomly to get an angioplasty or to be treated with clot-busting drugs.
Results, reported in the April 17 issue of the Journal of the American Medical Association, showed that the combined incidence of death, repeat heart attacks or strokes was lowered by 40 percent for the angioplasty patients six weeks (11 percent vs. 18 percent) and six months (12 percent vs. 20 percent) later. In addition, the angioplasty group had a shorter stay in the hospital, averaging four and one-half days compared to six days for the drug group.
"Our study and others suggest angioplasty is the better treatment, yet nearly two-thirds of heart attack patients present to hospitals that don't have that capability," says Thomas Aversano, M.D., lead author of the study and associate professor of medicine at Hopkins. "Given the superiority of primary angioplasty over thrombolytic therapy, it is important that health care policy be amended to provide the greatest number of patients access to this better form of therapy. It should not be a matter of chance or geography that determines what kind of care a heart attack patien
Contact: Karen Blum
Johns Hopkins Medical Institutions