Study Questions Heart Attack Treatment

A provocative new study challenges the notion that heart attack victims have only 12 hours in which to undergo an artery-clearing angioplasty.

The study found that patients who had the procedure as much as two days after being stricken still benefited.

The study was published in today’s Journal of the American Medical Assn. and led by Dr. Albert Schomig of Technische University in Munich, Germany.

Although the study was too small to be conclusive, the findings “are a noteworthy challenge to existing dogma and an important contribution to current knowledge,” Drs. Raymond Gibbons of the Mayo Clinic and Cindy Grines of William Beaumont Hospital in Detroit said in an accompanying editorial.

Cardiologists generally believe they have a 12-hour window after a heart attack starts to reopen clogged arteries and save heart muscle from damage caused by interrupted blood flow. Guidelines discourage performing angioplasties beyond that window.

In the study of 365 European patients hospitalized between 12 and 48 hours after symptoms began, patients who got immediate angioplasties had substantially less heart-muscle damage than those treated initially with drugs alone.

Tests several days after treatment showed that 8% of the heart muscle was damaged in the angioplasty patients versus 13% in the others.

Less heart muscle damage usually means a better outcome. There were fewer deaths, recurrent heart attacks and strokes among the angioplasty patients within 30 days of treatment. But the study was too small to determine whether that was due to chance.