And most would immediately get sent for an emergency angioplasty, which uses a tiny balloon to clear blood clots that are clogging arteries. Study after study has shown that quick access to this life-saving treatment, also called percutaneous coronary intervention, surpasses fibrinolytic (clot-busting) drugs in emergency heart attack care.

But in the real world, the difference between the two therapies may not be so simple.

According to a new analysis by researchers from the University of Michigan Cardiovascular Center, angioplasty only beats clot-busters if there's less than a one-hour difference between the time it takes to get patients from the emergency room door to the angioplasty suite, and the time it takes to start clot-busting drugs.

And in the real world, that swift access to angioplasty doesn't happen nearly as often as it should, says Eric R. Bates, M.D., professor of cardiovascular medicine at the U-M and senior author of the new study published in the October American Journal of Cardiology. Most hospitals still don't have the staff and equipment needed to do angioplasty, and it can take over an hour to transfer a patient to a hospital that does.

The result? "A delay to get an angioplasty means it may not get you all the benefits you read about," says Bates. "If you can't get angioplasty right away, get medical therapy with clot-busting drugs, and then transfer for angioplasty afterward."

Of course, he says, patients can also boost their chances of survival by getting to a hospital promptly after symptoms begin. The biggest delay is often the delay in getting any sort of medical attention, either because patients don't seek help or they don't call for emergency transportation. Half of heart attack patients get to the hospital by car, rather than by ambulance.

Bates, who p
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Contact: Kara Gavin
kegavin@umich.edu
734-764-2220
University of Michigan Health System
30-Sep-2003