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
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
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
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.
Also ask the emergency crew to take you to a hospital that can do angioplasty.
They may not be able to, given city or state rules, or they may decide
you aren’t stable enough for a longer trip. But it never hurts to
- 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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