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Sep 09, 2013

Preventive Measures May Save Heart Attack Patients

Performing a more extensive angioplasty could effectively treat heart attacks and help prevent future ones.

When it comes to treating heart attacks, time is of the essence. With each minute that blood flow is blocked in the heart, heart muscle can be damaged or even destroyed. So when a patient suffers a heart attack, their doctor’s No. 1 goal is to restore normal blood flow to the heart as soon as possible. But according to a study published in the New England Journal of Medicine, they should also be taking measures to help prevent future heart attacks.  

Results of this study were presented at the European Society of Cardiology Congress in Amsterdam, where thousands of medical experts came together to share the latest research findings in the field. Referred to as the PRAMI (Preventive Angioplasty in Acute Myocardial Infarction) trial, this study tested the use of “preventive angioplasty” in patients with the most serious type of heart attack (ST-segment elevation myocardial infarction, aka STEMI), where a blood clot completely blocks an artery in the heart. Since STEMI heart attacks can cause severe damage to the heart muscle, the priority in treating this type of heart attack is to open the artery as quickly as possible through angioplasty—a minimally invasive procedure that uses a thin tube to unblock or widen blocked arteries. And when the procedure is performed, doctors treat only the blocked arteries causing the heart attack. But researchers wondered if they should also be treating other narrowed arteries that could cause future heart attacks, while they’re at it.

A total of 465 patients with STEMI heart attacks participated in this study, all of which underwent angioplasty to restore blood flow in blocked arteries. The only difference was that half of the patients had a more extensive angioplasty (aka “preventive angioplasty”) in which doctors also treated other narrowed arteries that could cause trouble in the future. These preventive measures were so effective that the study was stopped early. After following patients for just under two years, researchers found that patients receiving the more extensive angioplasty had nearly one-third the risk of heart attack and death compared to those who didn’t.

These findings go against current treatment standards for STEMI heart attacks, which is to only treat arteries causing the event. Until now, experts believed that doing more than necessary during angioplasty puts added stress on the health of patients and that medication is more effective in reducing risk of future complications. In short, they believed that the risks far outweighed the benefits of performing a more extensive angioplasty.

But this study shows that times are changing. Heart attack patients, especially those having a STEMI heart attack, have a very high risk of suffering a future cardiac event and it’s important that we do everything possible to reduce that risk. Angioplasty has become increasingly safe in recent years and it’s possible that treating unhealthy arteries during emergency procedures may not be as risky as previously believed. With more research, it’s possible that standards for treating heart attacks may change but it will take time to understand and perfect these best-practices.

Questions for You to Consider

  • What is the difference between unstable angina, ST Segment Elevation Myocardial Infarction (STEMI) and Non-ST Segment Elevation Myocardial Infarction (NSTEMI)?
  • STEMI and NSTEMI are two classifications for a heart attack. Although both result from the interruption of blood supply to a part of the heart, STEMI results in ST-elevation (elevation of a cardiac enzyme) while NSTEMI does not. Unstable angina, on the other hand, is a condition characterized by chest pain or discomfort that is unexpected and usually occurs at rest. Unstable angina is often accompanied by shortness of breath, indigestion and/or dizziness. Unlike STEMI and NSTEMI, which cause muscle damage in the heart, unstable angina is not associated with muscle damage. However, unstable angina is very dangerous, may progress to a heart attack, and needs emergency treatment.

    Unstable angina and NSTEMI often appear identical at first presentation. The difference can be ascertained only after an ECG and blood tests to look for markers that indicate heart muscle damage.

    Call 9-1-1 immediately if you have the following symptoms:

    • Chest pain, pressure, tightness, or heaviness.  This discomfort may radiate to the neck, jaw, shoulders, back, or one or both arms.
    • Weakness, dizziness, lightheadedness, loss of consciousness.
    • Indigestion or “heartburn”; nausea and/or vomiting associated with chest discomfort
    • Shortness of breath that does not go away
  • What is percutaneous coronary intervention (PCI)?

  • Percutaneous coronary intervention (often referred to as balloon angioplasty or simply angioplasty) is often recommended for patients diagnosed with diseased arteries of the heart (coronary arteries) or for patients suffering a heart attack. Percutaneous coronary intervention includes a variety of procedures developed to compress fat and cholesterol build-up in the arteries, known as plaque deposits, to help increase the size of narrowed or blocked arteries and improve blood and oxygen flow to the heart.

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