Many heart attack patients still not receiving emergency angioplasty

Updated 11:00 AM August 13, 2007

Many heart attack patients still not receiving emergency angioplasty

By Kara Gavin
UMHS Public Relations

Far more of today's heart attack patients receive emergency angioplasty treatment or clot-busting drugs to re-open their clogged heart arteries than even a decade ago, a new study finds.

But 10 percent of patients who could benefit from this urgent treatment, which is known to save lives and prevent lasting damage to the heart muscle, don't get it, the study shows.

And the chance of missing out on lifesaving emergency treatment was highest among those patients whose heart attack symptoms don't include typical symptoms like chest pain, those who didn't reach the hospital until six or more hours after the start of their attack, women, people over age 75 and non-white people.

The study, published in the American Journal of Medicine by a team led by cardiologists from the Cardiovascular Center and the Yale University School of Medicine, is based on data from 238,291 patients who had a type of heart attack between 1994 and 2003 for which this therapy is appropriate.

It's the most current and comprehensive look at the use of emergency reperfusion, a term that describes treatments that can break up blood clots and other blockages in the tiny blood vessels of the heart and restore blood flow to the heart muscle.

In the 10-year study period, the percentage of patients who could have received emergency reperfusion but didn't declined from more than 20 percent to 10 percent, a notable achievement that the authors attribute to the increasing evidence of the benefit of emergency angioplasty, and the rise in the availability of the treatment at American hospitals and concerted national efforts to improve care.

The database used for the study, called the National Registry of Myocardial Infarction, includes detailed information about each patient's condition that can be used to determine if they would meet the criteria to receive emergency angioplasty or treatment with fibrinolytic (clot-busting) medications.

Those details reveal the troubling gap between the number of patients who could have received the treatments, and those who actually did.

"We may never be able to get to 100 percent, but 10 percent of eligible patients going untreated is still too many," says first author Dr. Brahmajee Nallamothu, assistant professor of cardiovascular medicine at the Medical School.

Adds senior author Dr. Harlan Krumholz, "This study has good and bad news. We have definitely made progress in treating appropriate patients, but our findings indicate that we need to improve further to be sure that no patient who could benefit from this treatment is missed." Krumholz is the Harold H. Hines Jr. Professor of Medicine in the Section of Cardiovascular Medicine and director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation.

The study was funded by the National Heart, Lung and Blood Institute of the National Institutes of Health. Genentech, Inc. provided the researchers access to the registry, which it sponsors.

The fact that 10 percent of possible emergency angioplasty candidates still aren't getting the procedure at all is a significant issue of its own, the authors say. Increasing its use in patients could save up to an additional 30 lives for every 1,000 heart attack patients treated when performed in a timely manner.

The authors state that hospitals should be judged in part by their ability to deliver acute reperfusion to as many candidate patients as possible. "Our findings support the incorporation of a measure of reperfusion use into national quality improvement efforts," they write. An American College of Cardiology/American Heart Association task force has endorsed this same idea.

Many heart attack patients still not receiving emergency angioplasty

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