Angioplasty Better than Clot-busting Drugs

MGH Heart Lab helps cut risk of death, but not all Marin residents get this treatment

A major study of heart attacks, published in last week’s prestigious New England Journal of Medicine, demonstrates that heart attack victims have better results if they have treatment at hospitals with special Cardiac Catheterization Labs, rather than getting clot-busting drugs at hospital emergency rooms in hospitals without the special labs.

These findings, based on a large Danish study, support Marin General Hospital cardiologists’ longstanding belief that Marin residents suffering from heart attack symptoms would fare better if brought immediately to MGH, which has the only Cardiac Cath Lab in Marin County.

An accompanying editorial in the New England Journal concludes that emergency angioplasties are so much better than drugs, clot-busting drugs, that it is worth transferring a patient from a hospital without a Cardiac Cath Lab to a hospital that has one.

“This is especially the case if two hours or less have elapsed since the time the patient noticed the symptoms,” explained Dr. Brian Strunk, cardiologist and chief of the hospital’s Cardiac Catheterization Lab. “Treatment in a Cardiac Cath Lab like MGH’s is more effective than administering clot-busting drugs. The mechanical method we use to open up clogged arteries in our Cath Lab is faster and more effective than the drugs in saving heart muscle. And the more heart muscle that is saved, the better chance of recovery - and the better chance of a return to a good quality of life.

“Right now, Marin residents who are having heart attacks are not always brought to MGH for their emergency care. With this study, we now have a definitive conclusion: if it’s been two hours or less since the patient noticed the heart attack symptoms, the study results indicate that ambulances should bring them directly to MGH, where our 24 hour Emergency Heart Team can open up their clogged arteries.”

Recently, the MGH team was found to exceed national standards for quick response to heart attacks. The team was also found to have patient survival rates that are better than in the Danish study. According to the National Registry of Myocardial Infarction (NRMI), heart attack patients arriving at MGH’s Emergency Department are more than twice as likely to receive emergency angioplasty within the optimal 90 minute time period than patients at the average California hospital.

“The best way a heart attack victim can assure his/her survival and quality of life after a heart attack is now clear,” said Dr. Joel Sklar, Medical Director of MGH's Heart Institute. “Call 911 immediately upon noticing the symptoms. Don’t delay. And get to a hospital that has an on call Cardiac Cath Team so that you can get the treatment that we now know is the best.

“We’ve known for some time that time is of the essence. Now, we know that emergency angioplasty is the preferred treatment over clot busting drugs if the treatment can be given within a two hour time frame.”

MGH’s Cardiac Catheterization Lab has performed over 8,000 heart procedures since it opened 10 years ago. Marin General Hospital is a not-for-profit hospital and is an affiliate of Sutter Health, a not-for- profit network of 26 hospitals in Northern California

Aug. 28, 2003