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It's never too late to 'hurry up' angioplasty treatment

coronary intervention (PCI)) from 1999 to 2002 at 395 hospitals within 6 hours of alerting health care providers to their symptoms.

Overall, when patients underwent angioplasty (in which a tiny balloon is threaded into a narrowed coronary artery and inflated to reopen blood flow) within 90 minutes of arriving at a hospital, 3 percent died in the hospital. That in-hospital mortality rate rose to 7.4 percent for patients who were in the hospital for more than three hours before being treated.

When the researchers analyzed subgroups of patients who had arrived at a hospital within an hour of reporting symptoms, between one and two hours, or longer than two hours, they still saw the same pattern: within each subgroup, faster action in the hospital meant lower death rates. The same benefits of swift hospital response were seen regardless of whether patients had high-risk factors or not.

The results of this study indicate that while getting to the hospital as quickly as possible is vital, rapid action by the hospital makes just as much of a difference for patients who come in late as it does for those who arrive right away.

"I think the most surprising finding is that mortality decreases with shorter door-to-balloon time to a similar degree for each group, regardless of time to presentation. Many clinicians think that time matters much more for early presenters than for late ones," Dr. McNamara said.

Co-author Harlan M. Krumholz, M.D., S.M., said the nature of heart attacks and how patients perceive symptoms may help explain why quick work in the hospital is important for all patients.

"From my perspective, the reason that time of onset to hospital presentation is not so important is because many patients may not completely occlude their arteries at the time they first recognize symptoms -- and so the actual time of artery occlusion may not be easily predicted from the time it takes them to present to the hospital. Also, som
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Contact: Amy Murphy
amurphy@acc.org
301-581-3476
American College of Cardiology
2-Jun-2006


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