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Jun 30, 2016

Treatment Lags for Heart Attack Patients With Prior Surgery

Patients with history of angioplasty or who had no previous interventions are treated faster, study finds.

After having a heart attack, it is crucial for patients to have blood flow restored to the heart within 90 minutes. This is especially true for patients who already have had coronary artery bypass surgery. Yet these patients may be the last to be treated. They were less likely than other heart attack patients, including those with prior angioplasty, to be treated within the 90-minute window, according to a study published in the JACC: Cardiovascular Interventions.

Using data from the American College of Cardiology’s CathPCI Registry linked with the ACTION Registry-GWTG, researchers examined records of 15,628 heart attack patients treated at 297 U.S. hospitals between June 2009 and September 2011. Of that group, 6% had a history of previous coronary artery bypass surgery, 19% had previous angioplasty, and 75% had no history of procedures.

Heart attack patients with a history of coronary bypass surgery were older, with an average age of 66, than those with prior angioplasty, average age 60, or without any previous interventions, average age 59; and were more likely to have other medical conditions, including high blood pressure, high cholesterol and diabetes.

Results showed that 76% of patients with prior revascularization via open heart surgery were treated within the recommended 90-minute timeframe compared with 88.5% of patients with prior angioplasty and 88% of patients with no previous interventions.

Overall, a little more than 88% of patients in the prior surgery group had successful procedures compared with about 93% of patients who had a prior angioplasty and 94% of patients with no prior interventions. After adjusting for clinical and procedural differences, the study found no significant differences in in-hospital death, major adverse events, and major bleeding among the three groups.     

Luis Gruberg, MD, FACC, the study’s lead author and professor of medicine at Stony Brook University in New York, noted that patients with a history of prior coronary artery bypass surgery have more complex anatomies and other medical conditions, making it harder for them to be treated promptly. “Nonetheless, every effort should be made to improve timeliness in patients with a history of previous coronary artery bypass surgery,” Gruberg said.
Read the full article in the JACC: Cardiovascular Interventions.

Questions for You to Consider

  • What is angioplasty?
  • Angioplasty (also called percutaneous coronary intervention) is often recommended for patients diagnosed with diseased arteries of the heart (coronary arteries) or for patients suffering a heart attack. Angioplasty 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.
  • Why is angioplasty done?
  • Angioplasty is used to open narrowed or closed arteries that lead to the heart. Angioplasty is most commonly used to treat heart attack or to help prevent a heart attack in patients with plaque build-up.
  • What is coronary artery bypass grafting?
  • Coronary artery bypass grafting (CABG) is a surgical procedure used to treat coronary artery disease, or the build-up of plaque in the heart’s arteries. During CABG, a healthy artery or vein is connected to a blocked artery in the heart to divert blood and improve blood flow.
  • Who needs coronary artery bypass grafting?
  • Coronary artery bypass grafting (CABG) is used to treat people with severe coronary artery disease. CABG is often recommended when other treatments like lifestyle changes and medications don’t work. CABG may also be recommended if there is significant blockage of the arteries that requires immediate treatment. Doctors can determine whether a patient with coronary artery disease is a candidate for CABG based on a physical exam and other tests.

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