One in four patients at risk if surgery delayed after failed angioplasty

ORLANDO, FLA. - Duke Clinical Research Institute and Canadian cardiologists have estimated that 25 percent of patients who unexpectedly require emergency heart surgery after a failed angioplasty are at risk of harm or death if any delays to the surgery are encountered.

While the number of patients potentially at risk is relatively low - between one and two per 1,000 angioplasty procedures - the researchers believe that it is a significant health care issue, especially if the center performing the angioplasties places the financial benefits of the popular and profitable procedure ahead of patient safety.

The results of the analysis were presented today (Nov. 12, 2003) at the 76th annual scientific session of the American Heart Association (AHA) by Mat Lotfi, M.D., researcher at the Duke Clinical Research Institute.

Debate continues within the cardiology community about whether "free-standing" angioplasty centers that do not have ready access to heart surgery place patients at undue risk, should something go wrong during the artery-opening procedure. Current guidelines of the AHA and American College of Cardiology state that institutions without surgical capability need to have a system in place to get patients to an operating room within one hour.

However, the investigators believe resorting to such transfers is not always in the best interest of patients, since not only can it be difficult to transfer a patient from one institution to another in less than an hour, but often the patients are too medically unstable after a failed angioplasty to survive a trip in an ambulance or helicopter.

"The results of our analysis show the unpredictability of the need for emergency surgery and demonstrate that certain patients will undoubtedly be put at increased risk without the immediate availability of cardiac surgery," Lotfi said. "We as cardiologists should develop strategies that ensure that our patients are not being placed at increas

Contact: Richard Merritt
Duke University Medical Center

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