Heart Beat

Double treatment for heart attack

If you are having a heart attack, it's best to be rushed to a hospital where you can undergo artery-opening angioplasty. Hospitals without that capability can offer a clot-busting drug. It's a good second choice that often, but not always, opens a blocked coronary artery. If you get a clot buster, does it make sense to be transferred to a different hospital for angioplasty once you are stable? A large Canadian trial says yes.

Heart attack victims seen at three dozen Canadian hospitals without the facilities to perform angioplasty were randomly assigned to get a clot-busting drug or to get the drug and also be moved within six hours to another hospital for angioplasty. Among those who got the drug alone, 17% had another heart attack, recurrent chest pain, new or worsening heart failure, or died in the next 30 days, compared with 11% of those who had follow-up angioplasty (New England Journal of Medicine, June 25, 2009).