A procedure called angioplasty, in which a tiny balloon is used to unclog arteries, appears to be a more effective in treating heart attack survivors than clot-busting drugs, researchers said this week.
Studies conducted in Michigan and the Netherlands found that people who undergo angioplasty within hours of being stricken with a heart attack generally fared better than those who were given the clot-dissolving drugs t-PA or streptokinase.A third study by researchers at the Mayo Clinic in Rochester, Minn., found that among 103 heart attack patients who received either angioplasty or t-PA, those given the balloon therapy had an average three days shorter hospital stay. All three reports appeared in The New England Journal of Medicine.
"In my mind, it sort of settles things. I think angioplasty is better, especially for high-risk patients," said Dr. Cindy Grines of William Beaumont Hospital in Royal Oak, Mich., who led one of the trials.
However, in an editorial accompanying the studies, Drs. Richard Lange and L. David Hillis of the University of Texas Southwestern Medical Center in Dallas said because of the limited availability of hospital angioplasty facilities, clot-dissolving medications may still be the best option for most patients.
In Grines' study, conducted at 12 medical centers, 395 people hospitalized for heart attacks were assigned either to receive t-PA or to undergo immediate angioplasty to clear fatty blockages from arteries.
During a six-month follow-up period, 16 percent of the 200 people in the t-PA group either died or had another heart attack, compared to 8.5 percent of the 195 patients who had angioplasty, researchers said.
In addition, they said there was a lower incidence of dangerous bleeding in the angioplasty group and better heart function.
In the Dutch study, led by Dr. Felix Ziljstra of Ziekenhuis de Weezenlanden in Zwolle, scientists compared treatment outcomes for 72 heart attack victims who were given streptokinase and 70 people who underwent angioplasty within hours of being stricken.
Nine who received intravenous streptokinase subsequently had another heart attack, but none who underwent angioplasty, the researchers said.