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Emergency Angioplasty
System is a Life-Saver in Ottawa, Canada
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January 16, 2008 -- A reports
in tomorrow's issue of the New England Journal of Medicine describes
a protocol that reduced mortality in the emergency treatment
of heart attacks in Canada's capital
city of
Ottawa
during
2005-06.
It
is well-known
that emergency
angioplasty
is
the number
one treatment for a heart attack, or myocardial infarction,
which is caused by a sudden blockage in one of the major coronary
arteries. The blockage is opened by a balloon and blood flow is
restored, instantly stopping the heart attack in its tracks.
Emergency angioplasty (also called PCI, for "Percutaneous
Coronary Intervention") has been one of the miracles in the
treatment of acute heart disease. Thirty years ago more than 1
in 4 heart attack victims died in the hospital. Today 95%
survive. A heart attack is no longer a death sentence. The problem
has been getting the patient to this treatment quickly enough:
90 minutes
has been
cited
in
a number
of studies
as the
window within which angioplasty should be performed for optimal
results. Studies have shown that for every 30 minute delay, one-year
mortality is increased by 7.5%.
Cardiologists are well aware that the challenges
of getting the patient to treatment in time are many: the patient
needs to be diagnosed
quickly;
there
must
available
catheterization laboratories where emergency angioplasty can be done,
either in the same hospital as the ER, or one nearby; the cath labs
must operate on a 24-hour basis; hospital staff needs training to
identify
patients suffering a heart attack (myocardial infarction) and to
transport them to a cath lab without giving them thrombolytic drugs
(so-called "clot
busters")
which have
been shown to not be as effective as primary PCI. In the United States,
the American College of Cardiology created the "Door-to-Balloon Alliance"
to address these issues -- specifically speeding up the time from
"door", when the patient presents at the Emergency Room, to "balloon",
when the angioplasty balloon is actually inflated in the blocked
artery.
However, in Ottawa, a unique protocol was established and many patients
never went to an Emergency Room to be diagnosed and referred to
an angioplasty center. Instead they were triaged by the Emergency
Medical personnel right in the
ambulance and brought directly to the cath lab of a high-volume PCI
hospital. The results were significant: the median door-to-balloon
time for those brought directly to a cath lab was 69 minutes. For
those who had to be referred from an Emergency Department, the time
was almost double: 123 minutes. At the end of 30 days, mortality
for the patients who were taken directly to an angioplasty hospital
was 4.4%; for those who were referred through an Emergency Department
the mortality
rate
was 5.7%,
or 30%
higher.
The results of this study, which involved 344 consecutive patients,
should provide an impetus for urban centers everywhere to begin
implementing training protocols to provide this life-saving treatment
for all citizens.
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