Study: Lifesaving angioplasty can be done at many more hospitals

Tuesday, April 16th 2002, 12:00 am
By: News On 6

CHICAGO (AP) _ Angioplasties can safely be done on heart attack victims at hospitals that do not have cardiac surgery departments, according to a study that could help make the lifesaving procedure available to many more patients across the country.

Numerous studies have shown angioplasty is the best treatment for heart attacks. But some medical standards and state regulations say doctors should perform angioplasties only at hospitals that have a cardiac surgery unit in case something goes wrong.

The new study challenges that thinking.

The study involved giving three months of angioplasty training to staffers at 11 of these hospitals.

At six weeks and six months after their heart attacks, patients treated with angioplasty had 40 percent lower rates of death, strokes and recurrent heart attacks than those given the clot-dissolving medication Activase. They also had shorter hospital stays, and none had complications requiring surgery.

The angioplasty patients fared about as well as those who undergo the procedure at surgery-ready hospitals.

The findings appear in Wednesday's Journal of the American Medical Association.

``It should not be a matter of chance or geography that determines what kind of care a heart attack patient receives,'' said Dr. Thomas Aversano, a Johns Hopkins Hospital cardiologist who led the study.

About two-thirds of U.S. heart attack patients each year do not get angioplasties because they are taken to hospitals without cardiac surgery units. In fact, most U.S. hospitals do not have such units.

The new findings show that after careful training, angioplasty for treating heart attacks can be performed successfully at these hospitals, Dr. Christopher Cannon of Harvard's Brigham and Women's Hospital said in an accompanying editorial.

Angioplasty is not considered surgery. It typically involves threading a thin tube, or catheter, tipped with a deflated balloon into an artery, where the balloon is inflated to clear a blockage. Small tubes called stents often are installed during the procedure to keep the artery propped open; 70 percent of angioplasty patients studied received them.

About 1.1 million Americans each year have heart attacks, and more than 40 percent die.

Letting hospitals without cardiac surgery units perform angioplasties could more than double the number of heart attack patients who receive the procedure, potentially saving many more lives, Aversano said. The benefits far outweigh the small risk of complications requiring surgery, he said.

American College of Cardiology/American Heart Association guidelines created in 1993 recommended against doing angioplasties at hospitals without cardiac surgery units. They were revised last year to say angioplasty for heart attacks is acceptable, with a number of caveats. Hospitals should have rapid access to a surgical facility, they should perform at least 36 angioplasties a year, and doctors who perform the procedure should do at least 75 a year, the guidelines say.

``Angioplasty has gotten safer and safer,'' especially with the widespread use of stents, said Dr. David Faxon, the heart association's president.

The 1996-99 study, which involved 451 patients, dealt only with angioplasties done to treat heart attacks. Doctors who performed the procedure were required to have done at least 50 angioplasties per year, all at other hospitals.

Genentech Inc., which makes Activase, said the study does not address how angioplasty compares with the company's newer clot-busting medication.