Study may show new standard for heart attack treatment


Wednesday, August 9th 2000, 12:00 am
By: News On 6


A clot-busting drug that is standard treatment for heart attacks is less effective than a new technique in which surgeons put a small mesh tube in an artery and give the patient "super
aspirin," a study indicates.

The new method worked better because it saved more of the heart, doctors said, but it may not be practical in the United States
because few hospitals are equipped to insert the tube quickly.

In the study, published in Thursday's edition of the New England Journal of Medicine, doctors at the Deutsches Herzzentrum (German Heart Center) found that after six months, 8.5 percent of the patients given the the two-part treatment had died or had a stroke or another heart attack.

That compared to 23.2 percent of those who got the clot-buster ATP, Dr. Albert Schoemig wrote.

The new treatment limited damage to an average of 14.3 percent of the left ventricle, the muscular chamber that pumps blood out to
the body, compared with 19.4 percent damage in ATP-treated hearts.

With only 140 patients, the study is small, but it was the first ever comparing the treatments, and the results were "very provocative," said Dr. Eric Topol of The Cleveland Clinic
Foundation.

"What it brings up now is whether we have reached a new standard of care," he said. More and larger trials are needed, he said.

Many U.S. hospitals may not be able to get the German team's results, he said.

Almost any U.S. hospital can give a dose of clot dissolver. But far fewer are equipped to install stents -- small mesh tubes designed to keep arteries open -- especially at off hours when angioplasty and backup surgical teams are not available.

Topol said most U.S. hospitals have to call in a special team to insert a heart catheter and the stent. It usually takes 11/2 to two hours after a heart attack patient shows up to unblock the artery, he said.
Because of that, he said, it may make more sense to give a half-dose of a clot-buster plus the "super-aspirin," called abciximab, when the patient arrives, with the stent inserted as
soon as possible.

Like aspirin, abciximab keeps platelets and proteins from clumping, but it is much stronger.

Topol said his hospital is starting a 3,000-patient test comparing Schoemig's treatment with his proposed refinement.
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On the Web:American Heart Association: http://americanheart.org

Heart Information Network: http://www.heartinfo.org

National Heart, Lung and Blood Institute:
http://www.nhlbi.nih.gov/index.htm

Deutsches Herzzentrum Munich (in German): http://www.dhm.mhn.de