Artery opening trumps clot busting

As late as a decade after Neil Armstrong walked on the moon, doctors could do little to stop a heart attack. They could offer support, something for pain, and drugs to ease the heart’s workload and keep blood from clotting readily. They could also halt the rhythm problems that sometimes surfaced. But they didn’t have any tools to get rid of an artery-blocking clot and restore blood flow to oxygen-starved heart muscle.

The advent of clot-busters such as tPA and streptokinase changed that. Instead of letting nature take its course, doctors could break the logjam and get blood flowing again. This saved lives and helped preserve heart function.

Now there’s an equally sweeping change afoot. An artery-opening procedure, balloon angioplasty (usually with the placement of a metal-cage stent), saves even more lives than clot-dissolving drugs. It’s also better at preventing repeat heart attacks and doesn’t cause bleeding in the brain, a possible side effect of drug therapy.

The catch is that only a minority of U.S. hospitals are set up to do emergency angioplasty, while virtually all can administer clot-busting drugs.

As things stand now, simple geography could keep you from getting an angioplasty if you’re having a heart attack. That’s because in most cities an ambulance will whisk you to the nearest hospital, not necessarily the one with the best treatments available.

In some places, these rules are changing. Emergency medical crews in Boston now hook people they suspect of having a heart attack to a sophisticated mobile electrocardiograph machine. If the heart’s electrical activity indicates a blocked artery, the ambulance heads straight for a medical center that can do angioplasty. Several states have similar programs in the works.

Research is now showing that a fast, aggressive approach to heart attacks saves lives. Across the country, emergency crews take people with serious injuries to regional trauma centers even if they have to pass other hospitals en route. The experienced doctors and state-of-the-art facilities available at a trauma center make this delay well worth it.

Until there are regional heart attack centers, here are some steps you can take to steer yourself toward a hospital that offers round-the-clock angioplasty if you’re having a heart attack.

• Ask your doctor where you would be taken if you called 911 about a possible heart attack. If the policy in your area is to take you to the closest hospital, ask him or her to write a letter for you saying that if you are stable you should be taken to, or immediately transferred to, a center that can perform emergency angioplasty.
• If your city or area doesn’t have a regional heart attack center, call or write your mayor, city officials or state legislators, and the medical directors of the local hospitals urging them to adopt the same system for heart attack treatment as is used for serious trauma.

May 2004 Update

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