THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Thursday, March 23, 1995 TAG: 9503230546
SECTION: FRONT PAGE: A4 EDITION: FINAL
SOURCE: BY MARIE JOYCE, STAFF WRITER
LENGTH: Medium: 98 lines
It's a debate that has been played out in hospitals, at medical conferences, and even on the television show ``ER.''
Should a heart attack victim be given drugs to break up the clot that's cutting off blood flow to the heart, or should he be treated with balloon angioplasty, a technique that opens up the blockage by inflating a small balloon in the artery?
It's more than an academic question - almost 7,000 people in South Hampton Roads died of heart attacks in 1993, the most recent year documented by the American Heart Association.
A newly released study, in which Virginia Beach General Hospital played a part, says that angioplasty may be the most effective.
Angioplasty is a common treatment for opening clogged arteries, but most of the time it's a scheduled procedure, not emergency treatment for a heart attack.
A common treatment is the use of drugs that dissolve the clot within 30 minutes or so. But the international study seems to show that emergency angioplasty is more effective, safer and ultimately more economical, says cardiologist Dr. John Griffin, even though the procedure is expensive. Griffin coordinated Virginia Beach General's part in the study, and this week he presented the results at an American College of Cardiology meeting in New Orleans.
It's a significant finding, he said, since most people who die from a heart attack do so within 48 hours of the event.
Overall, the death rate among heart attack patients getting the angioplasty was just under 3 percent - much lower than the 10 percent or so with clot-busting drugs, said Griffin.
For low-risk patients - those without certain complicating factors - the rate was very low, just 0.4 percent. That's equal to the rate for non-emergency angioplasty.
How and when emergency angioplasty should be used is still a matter of debate, said Griffin.
Hospitals generally only give routine angioplasty if they also have the facilities to do open heart surgery. That way, they have a backup if something goes wrong during the procedure. In South Hampton Roads, only Virginia Beach General, Sentara Norfolk General Hospital, and Children's Hospital of The King's Daughters offer open heart surgery.
But doctors who support emergency angioplasty argue that something already has gone wrong when a person has a heart attack. Many hospitals, including most in South Hampton Roads, have the necessary equipment, although they might not have experienced staff available round the clock, Griffin said.
He said doctors probably will used both techniques, depending on the circumstances.
``It's not applicable at every hospital in the country,'' he said. Doctors are still debating how to make best use of the study results.
For the time being, the most important thing is for a heart attack victim to get to the closest hospital as soon as possible, regardless of whether that hospital performs emergency angioplasty, said Dr. Jeffe St. Clair, Virginia Beach General cardiologist who worked on the study.
``The overriding drama is the quicker you get someplace, the better off you are,'' St. Clair said.
The question was a source of debate at the cardiologists' meeting this week, the Associated Press reported, and some doctors disputed the study's findings.
``Some of these investigators have been overstating the case based on small numbers of patients,'' said Dr. Eric Topol of the Cleveland Clinic. Topol helped pioneer the use of clot-dissolving drugs.
The angioplasty study also found that some heart attack patients who had the procedure can safely leave the hospital much sooner than they do now.
In standard treatment, a heart attack patient spends several days in an intensive care unit, then several more days in a regular hospital unit. During that time, he undergoes a battery of tests.
In the study, doctors were able to cut back that number safely by identifying which heart attack victims were ``low risk.'' They were patients under 70, who had never had bypass surgery and didn't have any of several other complications.
Half the low-risk patients in the study were given the standard treatment; the other half went immediately to a regular unit in the hospital. They weren't given some of the regular tests, such as an echocardiogram, which uses ultrasound to look at how the heart is moving.
Doctors found that the survival rate was the same, and the patients in the regular unit were released in three days - saving thousands of dollars. The study didn't address whether the same protocol could be used on patients who got the clot-busting drugs.
KEYWORDS: HEART ATTACKS ANGIOPLASTY STUDY by CNB