Heart Attack Survival Rates Better With Timely Angioplasty
Your chances of surviving a heart attack are far greater if you undergo the artery-clearing procedure known as angioplasty within two hours of arriving at the hospital.
But as many as half of all heart attack victims will not receive angioplasty within that two-hour time frame, according to researchers in Boston. The procedure involves inflating a balloon inside the artery to compress a blockage in the coronary artery and restore blood flow.
Dr. Christopher P. Cannon and his colleagues at Brigham and Women’s Hospital reported in last Wednesday’s Journal of the American Medical Assn. that 4.2% of those who received angioplasty within an hour of reaching the hospital died, compared with 7.9% of those who did not receive it until three hours or more after arrival.
When characteristics such as age and severity of the heart attack were factored in, they concluded that delaying angioplasty beyond two hours increased the chance of death by 40% to 63%. They also found that the death rate was 33% lower in hospitals that performed more than three angioplasties per month than in those that performed fewer than one per month. (https://jama.ama-assn.org).
Their findings are based on an analysis of data from the Second National Registry of Myocardial Infarction, which has data on 27,080 heart attack victims who underwent angioplasty in 661 U.S. hospitals between June 1994 and March 1998.
The study did not address the issue of why angioplasty was delayed in nearly half the cases. But the authors did find that those who received the treatment in the first hour were younger, more likely to be male, and less likely to have diabetes, a prior heart attack and prior bypass surgery--in other words, more likely to benefit from the procedure.
AIDS Drugs Linked to Bone Disease
The family of AIDS-fighting drugs called protease inhibitors are known to have some adverse effects. Now researchers have linked these therapies to a new problem: the development of a painful bone disease that can necessitate hip replacement surgery.
A new study from UC San Francisco indicates that protease inhibitors can cause avascular necrosis of the femoral head, a bone disease marked by tissue death in the top end of the thigh bone.
Protease inhibitors have markedly improved the treatment of HIV infection by preventing progression to AIDS, but the drugs have been linked to such adverse effects as changes in cholesterol metabolism, an increased risk of diabetes and the development of unsightly fat deposits.
Previously known risk factors for the bone disease include steroid use and alcohol abuse. The disease can be treated if it is detected in the early stages, but once it has progressed, the only alternative is a hip transplant. Treatment involves drilling small holes in the bone to increase blood flow.
Dr. Guy Paiement reported last Friday at a Hot Springs, Va., meeting of the American Orthopedic Assn. that UCSF physicians had treated 18 HIV-positive patients with the disease between 1991 and 1999. Eleven of the patients were using protease inhibitors, and only one of the 11 had any risk factors for the disease. Among the seven not taking protease inhibitors, only one did not have at least one risk factor.
Risk of Embolism Higher Than Thought
Birth control pills present a higher risk of pulmonary embolism--blood clots in the lungs--than had previously been thought, but the overall risk is still low, according to researchers in New Zealand.
Dr. David Skegg and his colleagues at the University of Otago Medical School in Dunedin studied all deaths from pulmonary embolisms between 1990 and 1998 among New Zealand women ages 15 to 49. Each woman who died--there was a total of 29--was matched with four healthy women of the same age.
The team reported in Saturday’s Lancet that 65% of the women who died had used contraceptives in the previous three months, compared with only 23% of the controls. Statistically, the birth control pill users were 10 times as likely as nonusers to develop pulmonary embolism. Overall, however, the absolute risk of death was 10.5 deaths per 1 million women-years of contraceptive use. (https://www.lancet.com)
Women Benefit Greatly From Daily Walks
Thirty minutes a day of moderate to vigorous exercise, such as a brisk walk, can reduce a woman’s risk of stroke by as much as 30%, according to researchers from Brigham and Women’s Hospital and the Harvard School of Public Health. The data comes from the ongoing Nurses’ Health Study, which is monitoring 72,488 female nurses in 11 states. During the eight years of follow-up, the team reported in last Wednesday’s Journal of the American Medical Assn., it observed 407 strokes. The overall risk was lowest in women who exercised at least 30 minutes per day. Previous results from the study show that the same amount of exercise can also reduce the risk of heart attacks by a similar amount. (https://jama.ama-assn.org).
New Treatment for Heroin, Cocaine Users
A combination of buprenorphine--an experimental alternative to methadone for treating heroin addiction--and Antabuse (disulfiram, normally used for treating alcoholism) provides an effective treatment for patients who are addicted to both heroin and cocaine, according to researchers from the Yale University School of Medicine. Each of the drugs used alone has been found useful in treating heroin addiction, but neither had any effect on concomitant cocaine use when used alone.
Dr. Tony P. George and his colleagues treated 20 individuals addicted to both heroin and cocaine. All received buprenorphine. Half also received disulfiram and half received a placebo. The researchers reported in the spring Biological Psychiatry, issued last Wednesday, that those receiving the drug combination were able to abstain from cocaine for longer periods of time.
Migraine Prescription Used for Hot Flashes
Gabapentin, a drug used to prevent migraines and seizures, may also be useful in combating hot flashes, according to anecdotal evidence reported in last Tuesday’s Neurology. Researchers have recently reported results from clinical trials suggesting that antidepressants can also reduce hot flashes in post-menopausal women or those receiving breast cancer therapy. Gabapentin is not an antidepressant, but it has been used for anxiety disorders and bipolar disorder.
Dr. Thomas Guttuso Jr. of the University of Rochester Medical Center in New York reported his experience with six patients. One, a 52-year-old woman who reported 10 to 15 hot flashes a day following a hysterectomy, began taking gabapentin to prevent migraines. Her hot flashes stopped within two days. Guttuso asked her to stop taking the drug and she had 17 hot flashes the next day. She started taking it again and has had no more. A 58-year-old man with prostate cancer who was suffering 15 hot flashes per day also had almost none after taking the drug.
Gabapentin may cause sleepiness, dizziness and clumsiness, but no long-term or harmful side effects have been reported.
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Medical writer Thomas H. Maugh II can be reached at thomas.maugh@latimes.com.
