Harvard Heart Letter

No benefit for late angioplasty after a heart attack

Opening a blocked coronary artery immediately after a heart attack pays off; doing it after a day or so doesn't.

You've been on the fence about that nagging chest pain and unusual fatigue for hours. You finally go to the hospital, where you learn you've had a heart attack and the artery that caused it is still blocked. It's been a day and a half since the symptoms started. What to do?

Until recently, many doctors would have recommended using a catheter and balloon to clear the blocked artery and leaving a wire-mesh stent behind to prop it open, even though you've passed the 12-hour window when this approach works best. An open artery has to trump a closed one, right? Not necessarily. Surprising results from a large international trial show that using a battery of drugs to protect the heart is at least as good, and may be better, for people with stable chest pain from a coronary artery that has been blocked for longer than 24 hours.

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