Study backs angioplasty for acute heart attacks

CTV News Medical Correspondent

What's the best way to treat a heart attack? A new study says rapid angioplasty, which opens a blocked artery with a tiny balloon, is the best way to go. But a leading cardiologist says there aren't enough angioplasty units in Canada due to limited resources.

Instead, many Canadian heart attack victims are treated initially with clot-busting drugs.

The study, published in the New England Journal of Medicine, says that drugs used to dissolve clots aren't always the way to go. But rapid angioplasty, which opens a blocked artery with a tiny balloon, isn't offered at every hospital.

The study, A Comparison of Coronary Angioplasty with Fibrinolytic Therapy in Acute Myocardial Infarction, followed more than 1,500 heart attack patients in Denmark. The researchers found that those who had angioplasty recovered faster and had fewer strokes.

Among those who had angioplasty, 1.6 per cent had a second heart attack within a month. In comparison, 6.3 per of those who received clot-busting drugs had a second heart attack.

Dr. Warren Cantor, a cardiologist at St. Michael's Hospital in Toronto, said many hospitals in Canada don't have the facilities to treat heart attack patients quickly. He believes the Danish study shows the direction to follow.

"I think we could use angioplasty in a greater number of patients and use it more effectively," Cantor said.

Still, Cantor said angioplasty is under used in Canada due to limited resources. He points out many community hospitals don't have angioplasty units and there are only a limited number of ambulances to transport heart attack patients to specialized centres.

The Danish study concluded that angioplasty is superior to drugs -- provided the transfer of the patient takes two hours or less.

In the study, patients admitted to local hospitals without angioplasty units were transferred to invasive-treatment centres. The median time for admission was 50 minutes, compared to the 75 minute delay reported in another recent study.

The Danish researchers said the transfer time between hospitals only accounted for 14 per cent of the total time between the onset of symptoms and the start of treatment. About 70 per cent of the patients were moved more than 25 kilometres.

"I don't think we're prepared to immediately start transporting all these patients to angioplasty centres, because our transport times are too long...our times to start the angioplasty are too long," Cantor said.

In an editorial that accompanied the study, Boston University Medical Center's Alice Jacobs said it's time for hospitals to start offering angioplasty "24 hours a day, seven days a week."

Jacobs also said it should be considered a standard method for unblocking arteries in heart attack victims.

Emmanuel Thomas, who had a massive heart attack two days ago, was able to get to a Canadian hospital offering angioplasty within the required time frame. Even though he can't find words to describe the sharp pain he experienced, he's already looking ahead.

"With this angioplasty they say there is a low chance of this happening again," Thomas said.

Dr. Andy Wielgosz, a spokesman with the Heart and Stroke Foundation of Canada, said it's probably "untenable" to make rapid angioplasty available at every hospital in Canada.

Wielgosz said it would potentially cost hundreds of millions of dollars to re-organize the health-care system. He said there's also the fear the public will forget that heart disease is largely preventable.

"If the general public sees the solution as a plumbing fix...you unclog the pipes and carry on...we won't get ahead...we'll always struggle to treat the disease," Wielgosz said.