By Drs. Joel Sklar, David Sperling and Brian Strunk

February 2001

It's 4 a.m. and a team of highly trained physicians, nurses and technologists are working fast to save a patient's life during the 'golden hour' before irreparable damage is done.

This scene has repeated itself at Marin General Hospital at all hours of the day and night, some 100 times during the past two years, with a survival rate that would be the envy of any medical community.

Who are these patients? Victims of automobile accidents? Gunshot wounds?

No. These patients are suffering Acute Myocardial Infarctions (heart attacks), the biggest killer of adult Americans, and they are in Marin General's Cardiac Catheterization Laboratory undergoing emergency angioplasty.

While accidents involving young people that tie up traffic for hours and may cause serious injuryor even death are terrible and make the front pages, there are many more medical emergencies everyday in Marin that don't make the 6 o'clock news. But for those who experience less 'spectacular' emergencies, the possibility of death or disability is just as real.

While the issue of trauma care in Marin has received widespread media attention during the past few years, our hope is that we do not lose sight of the rest of the medical emergencies that also require immediate care by physicians, paramedics and other medical personnel. There are fewer than 100 serious trauma cases in Marin each year, but more than 240 heart attack patients are treated annually at Marin General alone.

A major study published last spring in the New England Journal of Medicine examined 257,000 heart attack victims treated by emergency angioplasty (a way to immediately unclog a blocked coronary artery). The mortality rate at high volume angioplasty centers ­ those doing more than 33 primary angioplasties a year ­ was 5.7 percent. (Smaller programs generally had worse statistics.)

Marin General qualifies as a high volume center, with 106 emergency cases in the past two years.

A similar study published in the Journal of the American Medical Association (JAMA) on Dec. 27, and reported in the San Francisco Chronicle the same day, showed a 3.4 percent mortality rate at high volume centers.

At Marin General, we were able to save all 45 heart attack victims who initially presented at our Emergency Department and were treated by emergency angioplasty in 1999. Our two year mortality rate through last December was 0.9 percent, compared to a national rate of up to almost 6 percent for similar cases.

These new studies of primary angioplasty procedures confirm that Marin General is in the forefront of emergency cardiac care. We handled a high volume of cases and our mortality rate was less than 1 percent. We are pleased that we stack up so well compared to the biggest national studies to date, both in terms of volume of experience and in excellence of outcomes.

Although standard heart attack care for the last 10 years has been to attempt to open the blocked vessel with clot-busting drugs, we now believe, as the studies in the New England Journal of Medicine and JAMA demonstrate, that emergency angioplasty has emerged as a superior treatment.

We are proud to be able to offer this mode of therapy exclusively at Marin General Hospital and believe all our neighbors should understand its importance.

(Drs. Sklar, Sperling and Strunk are interventional cardiologists who perform all of the coronary angioplasties at Marin General Hospital.)