Although
angioplasty has been shown to save lives when completed shortly after a patient has a heart attack, those with cardiogenic shock, or low blood pressure that lasts for more than 30 minutes, are not benefiting as much as physicians had hoped. In fact, the death rate among these patients while still hospitalized increased from almost 28% between 2005 and 2006 to almost 31% between 2011 and 2013, according to a
study published in
JACC: Cardiovascular Interventions.
Using data from the American College of Cardiology’s
CathPCI Registry, researchers assessed records from 56,497 patients between January 2005 and December 2013. They noted differences in the way the two groups of patients were treated. The anti-coagulant bivalirudin, which has been shown to prevent problems following angioplasty in some studies, was used more frequently in the later time period than anti-coagulants such as heparin (about 13% earlier vs. 46% later). The use of an intra-aortic balloon pump, a mechanical device that helps the heart pump blood, declined in the 2011-2013 time period (almost 50% vs. about 45%). In addition, in the 2005-2006 time period, angioplasty was performed on more than one damaged artery in close to 32% of patients, compared with about 26% in the 2011-2013 period.
Siddharth A. Wayangankar, MD, the study’s lead author, expresses concern about the increased death rates, noting that “despite evolution of medical technology and utilization of contemporary measures, in-hospital mortality continues to rise.” Moving forward, he explains that there is a need for additional research and targeted efforts to improve outcomes in this high-risk group.
In an
accompanying editorial, Tanveer Rab, MD, FACC, suggests several reasons for the increased in-hospital death rates. He points to increased use of bivalirudin and incomplete repair of damaged vessels as two possible causes. Strategies that he believes could reverse this trend is using heparin as an anti-coagulant instead of bivalirudin and performing complete vessel repairs when possible.