ProHealth health Vitamin and Natural Supplement Store and Health
Home  |  Log In  |  My Account  |  View Cart  View Your ProHealth Vitamin and Supplement Shopping Cart
800-366-6056  |  Contact Us  |  Help
Facebook Google Plus
Fibromyalgia  Chronic Fatigue Syndrome & M.E.  Lyme Disease  Natural Wellness  Supplement News  Forums  Our Story
Store     Brands   |   A-Z Index   |   Best Sellers   |   New Products   |   Deals & Specials   |   Under $10   |   SmartSavings Club

Trending News

10 Fibro-Friendly Foods with a Bonus: Beautiful Skin

Fight Back! Win the War Being Waged Against Your Immune System

Studies Show that Magnesium L-threonate Improves Brain Plasticity, Leading to Direct and Significant...

The role of microbiota and intestinal permeability in the pathophysiology of autoimmune and neuroimm...

Clary Sage Oil May Be Pricey, but Its Benefits Are Priceless

Component of red wine, grapes can help to reduce inflammation, study finds

Poly MVA: A Novel Therapy for Increasing Energy, Repairing DNA, and Promoting Overall Health

Acupressure reduced fatigue in breast cancer survivors

Pumpkin Pie Turmeric Breakfast Smoothie - Vegan + Gluten-Free

Omega-3 fatty acid stops known trigger of lupus

Print Page
Email Article

Angioplasty Better than Thrombolytics after Heart Attack

  [ 10 votes ]   [ Discuss This Article ] • April 29, 2002

By Deborah Josefson, Nebraska

Primary coronary artery angioplasty, which is known to be superior to thrombolytic therapy in restoring blood flow to an ischaemic heart, can be safely implemented in hospitals that lack pre-existing angioplasty programmes and on-site cardiac surgery departments, a new study has found.

The report further suggests that treatment of acute myocardial infarction should be re-organised according to a trauma care model so that patients who have had a heart attack are preferentially directed to a facility where angioplasty is available (JAMA 2002;287:1943-51).

Although about 1.2 million Americans a year have heart attacks, 66% of them do not have access to hospitals that perform coronary angioplasty. Most community hospitals in the United States do not offer angioplasty despite the availability of trained interventional cardiologists and cardiac catheterisation facilities on-site, because in 1993 both the American College of Cardiology and the American Heart Association advised against the performance of angioplasties if cardiac surgery was not also available on-site.

This recommendation stemmed from the fear that angioplasties might lead to complications such as dissections, emboli, and acute occlusions without the possibility of correcting them with emergency cardiac surgery.

Because many previous studies have shown that angioplasty is superior to thrombolysis in achieving reperfusion, researchers from the Atlantic Cardiovascular Patient Outcomes Research Team sought to compare thrombolysis with angioplasty and to challenge the convention that has restricted angioplasty to medical centres with in-house cardiac surgery facilities. The researchers were led by Dr Thomas Aversano of the Johns Hopkins Medical Institutions in Baltimore, Maryland.

Before enrolling patients into the study, the investigators set up in each of the hospitals an angioplasty development programme, which provided a crash course in angioplasty care, trained staff, and set up quality control and management standards. The cardiologists who performed the angioplasties did, however, have previous experience in the technique and had to have done at least 50 of the procedures annually.

Inclusion criteria included chest pain lasting more than 30 minutes but less than 12 hours, age 18 years or more, ability to sign informed consent, and eligibility to receive thrombolytics and radiographic dye. Additionally, electrocardiographic changes diagnostic of myocardial infarction had to be present.

Patients with reduced creatinine clearance (creatinine over 1.5 mg/dl (124 m mol/l) in men or over 1.4 mg/dl in women) were excluded but comorbidities including previous myocardial infarction and previous bypass surgery and angioplasty were allowed in the study.

A total of 451 patients with acute myocardial infarction recruited from 11 community hospitals in Massachusetts and Maryland over three years were randomised into either a primary angioplasty arm or a thrombolytic arm with tissue plasminogen activator (tPA). Participants in both arms received aspirin immediately on presentation. Participants in the thrombolytic arm were started on tPA within 30 minutes of diagnosis and received heparin after thrombolysis for 48 hours.

In the angioplasty arm, the goal was to start balloon angioplasty within 90 minutes of arrival and to have the participants in the catheterisatiaon laboratory within an hour. Angioplasty was not done in patients who had clinical and electrocardiographic resolution of their ischaemia and normal flow on initial angiography.

The researchers found that at six months, the odds ratio for the composite end point (occurrence of death, recurrent myocardial infarction, or stroke) was 0.57 (95% confidence interval 0.34 to 0.95) in favour of angioplasty.

At six months, participants in the angioplasty arm experienced fewer complications and lower death rates than those in the thrombolytic arm. Mortality was 6.2% in the angioplasty cohort and 7.1% in the thrombolytic arm.

Moreover, 10.6% of those who received thrombolytics went on to develop another heart attack by six months, compared with only 5.3% in the angioplasty group. Strokes occurred in 4% of the thrombolytic group but in only 2.2% of the angioplasty group. Length of stay in hospital was also shorter in the angioplasty group—4.5 days v 6 days.

In a press release, Dr Aversano stated that he believed that healthcare policy should be amended to provide angioplasty to more patients. "It should not be a matter of chance or geography that determines what kind of care a heart attack patient receives," he said.

In an accompanying editorial (pp 1987-9), Dr Christopher Cannon of the Brigham and Women’s Hospital in Boston, Massachusetts, agreed with the study’s overall findings and suggestions but pointed out that the study was small and that to be truly effective the provision of angioplasties would have to be available 24 hours a day.

Source: BMJ 2002;324:996 ( 27 April )

Post a Comment

Featured Products From the ProHealth Store
Ultra ATP+, Double Strength Optimized Curcumin Longvida® Mitochondria Ignite™ with NT Factor®

Looking for Vitamins, Herbs and Supplements?
Search the ProHealth Store for Hundreds of Natural Health Products

Article Comments

Be the first to comment on this article!

Post a Comment

Natural Pain Relief Supplements

Featured Products

Ultra ATP+, Double Strength Ultra ATP+, Double Strength
Get energized with malic acid & magnesium
Vitamin D3 Extreme™ Vitamin D3 Extreme™
50,000 IU Vitamin D3 - Prescription Strength
Mitochondria Ignite™ with NT Factor® Mitochondria Ignite™ with NT Factor®
Reduce Fatigue up to 45%
Energy NADH™ 12.5mg Energy NADH™ 12.5mg
Improve Energy & Cognitive Function
FibroSleep™ FibroSleep™
The All-in-One Natural Sleep Aid

Natural Remedies

Aches and Pains? A Simple Solution You'll Love Aches and Pains? A Simple Solution You'll Love
Soothe, Heal and Regulate Your Digestive System with Nutrient-Rich Aloe Vera Soothe, Heal and Regulate Your Digestive System with Nutrient-Rich Aloe Vera
Studies Show that Magnesium L-threonate Improves Brain Plasticity, Leading to Direct and Significant Improvements in Memory, Learning, and Cognition.3 Studies Show that Magnesium L-threonate Improves Brain Plasticity, Leading to Direct and Significant Improvements in Memory, Learning, and Cognition.3
Front Line Defense Against Colds & Flu - Support for Healthy Immune System Balance Front Line Defense Against Colds & Flu - Support for Healthy Immune System Balance
Olea25 Olive Hydroxytyrosol Hits Astonishing 68,000+ ORAC Antioxidant Value Olea25 Olive Hydroxytyrosol Hits Astonishing 68,000+ ORAC Antioxidant Value

ProHealth, Inc.
555 Maple Ave
Carpinteria, CA 93013
(800) 366-6056  |  Email

· Become a Wholesaler
· Vendor Inquiries
· Affiliate Program
Credit Card Processing
Be the first to know about new products, special discounts and the latest health news. *New subscribers only

CONNECT WITH US ProHealth on Facebook  ProHealth on Twitter  ProHealth on Pinterest  ProHealth on Google Plus

© 2016 ProHealth, Inc. All rights reserved. Pain Tracker App  |  Store  |  Customer Service  |  Guarantee  |  Privacy  |  Contact Us  |  Library  |  RSS  |  Site Map