Study: Angioplasty Can Beat Drug

Wednesday, December 27th 2000, 12:00 am

By: News On 6

CHICAGO (AP) â€” When it comes to saving heart attack patients' lives, angioplasty beats clot-busting drugs, but only if done in hospitals that specialize in the procedure, new research suggests.

In hospitals with a low number of angioplasties, patients who had one died at about the same rate as those given clot-dissolving drugs, according to a study that looked at 62,299 heart attack patients.

At hospitals with high numbers of angioplasties, the in-hospital death rate was significantly lower in the 11,733 angioplasty patients â€” 3.4 percent versus 5.4 percent for 8,605 patients treated with clot-busters.

Whether one treatment is better than the other has been debated in previous research.

``This study may provide an explanation for the discordant results of previous studies,'' the researchers wrote in Wednesday's Journal of the American Medical Association.

Dr. David Magid, an emergency room physician for Kaiser Permanente in Denver who led the study, said hospitals that perform a lot of angioplasties are able to identify patients who need one and get it done faster.

Dr. David Faxon, president-elect of the American Heart Association, said the consensus among heart specialists is that angioplasty is superior ``when done in the right setting,'' and the new findings support that.

Both treatments have the same goal â€” to clear an artery blockage that deprives the heart of oxygen. In angioplasty, a balloon-tip catheter is threaded into the artery to open it. Clot-dissolving drugs are given intravenously.

Emergency angioplasty is performed in up to 80 percent of heart attack patients eligible for either type of treatment. It is generally believed to be more effective at opening a clogged artery, but requires more skill. Quick treatment, within 12 hours of symptoms, is required for both to be effective.

About 700,000 angioplasties are performed nationwide each year. That includes emergency angioplasties as well as elective ones, which are not done during a heart attack.

In the study, which involved 446 hospitals, high-volume centers were those that did at least 49 emergency angioplasties a year. Low-volume centers performed 16 or fewer.

Another study in the journal found that Medicare patients undergoing elective angioplasties and stent implants at high-volume hospitals had better 30-day survival rates and were less likely to need immediate heart bypass surgery than those treated at low-volume hospitals.

Studies done before the use of stents â€” small wire scaffold-like devices that are inserted into arteries to prop them open â€” found similar results, and Faxon said the new findings are not surprising.

The American College of Cardiology recommends that elective angioplasties be done by a doctor who has performed at least 75 of them and at hospitals that do at least 400 annually.

As for emergency angioplasties, the college and American Heart Association generally recommend that they be done at high-volume centers.

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On the Web:

http://jama.ama-assn.org

http://www.americanheart.org