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New Year: A New Lease on Life Angioplasty Stops Heart Attacks |
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January 3, 2007 -- In the flurry of news about drug-eluting stents, bare metal stents and how long to take Plavix, one of the great advances made possible by balloon angioplasty and stents is sometime forgotten: the ability of an intervention to stop a heart attack from progressing and, if administered in a timely manner as an emergency procedure, to reduce or completely eliminate damage to the heart muscle from a heart attack. An article today appearing in the Edmonton Journal (Alberta, Canada) details the story of one man, Roger Adams, who briefly died a month ago on a downtown street; that is, until a good samaritan, who luckily knew CPR, was able to revive him, and until an ambulance arrived, shocked his heart into a rhythm and whisked him off to University Hospital, where an angioplasty was done, opening his completely blocked coronary artery. A stent was then placed to keep the artery from collapsing. Doctors believe Mr. Adams suffered no permanent damage and, aside from the stent, is basically the same as he was before the heart attack. There are other details in the full article (see sidebar link) but the lesson from this story is the importance of getting heart attack victims to the cath lab quickly (within 3 hours, 90 minutes if possible) because angioplasty can stop the often devastating effects of a heart attack. "Time is muscle" goes the phrase -- and there is a narrow window during which the heart muscle can revive, if the blood supply is turned back on. Before angioplasty, a few patients got emergency bypass surgery, but usually heart attack victims in the ER had few options other than oxygen, some drugs and keeping still, in hopes that the damage would not be too great. What damage there was became permanent and all too often the result was a compromised heart that greatly impacted the victim's activities, leading many times to congestive heart failure and a shortened life span. Today the technology exists -- there are thousands of hospitals with catheterization laboratories and more are instituting emergency care protocols to decrease what is known as "door-to-balloon time". The American College of Cardiology and its partners are currently putting the final touches on an initiative called the "Door-to-Balloon (D2B) Alliance" and will announce developments at their March annual meeting in New Orleans. But, as discussed in this week's New England Journal of Medicine feature article, this is a complex issue that involves the coordination not only of cath lab and ER personnel, but the ambulance EMT systems, as well as community hospitals. These smaller hospitals, concerned about the problems of transport, sometimes recommend that the patient stay in their ER and receive thrombolytic therapy ("clot-busters") instead of being driven or air-lifted to a high-volume angioplasty center, even though virtually all studies, including the one in NEJM, show that "primary PCI", angioplasty performed first without the use of "clot-busters", is superior. Armed with the knowledge that an angioplasty can stop a heart attack in its tracks, the public may be able to move this D2B initiative forward even more quickly.
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