[OT} attack drugs before undergoing emergency revascularisation

Main Category: Cardiovascular/Cardiology News
Article Date: 17 Feb 2006 - 1:00am (UK)

A common practice for improving outcomes in patients with sudden heart
attack actually offers no benefit and could cause harm, according to a
review of randomised trials published online (Tuesday February 14, 2006) by
The Lancet.

Despite the lack of evidence for its safety and effectiveness, many doctors
believe the practice of giving patients with sudden ST-elevation* heart
attack drugs before undergoing emergency revascularisation procedures
(angioplasty or stent placement**) improves outcome. However, preliminary
studies have suggested this practice confers no benefit.

To investigate the effect of pre-intervention drug treatment, Ellen Keeley
(University of Texas Southwestern Medical Center, Dallas, TX, USA) and
colleagues reviewed data from 17 trials comparing the outcomes for
ST-elevation heart attack patients assigned the drug based procedure before
angioplasty/stent placement (2237) and those assigned angioplasty/stent
placement alone (2267). The investigators found that more of the patients
who received drugs prior to their intervention died than those who did not
receive medication (106 versus 78). Pre-intervention drugs also increased
the risk of non-fatal heart attack, bleeding, stroke, and the need for
repeat revascularisation treatment. These increased rates were mainly seen
when the pharmacological treatment was a drug that dissolved clots
(thrombolytic therapy).

Dr Keeley states: "Drug facilitated angioplasty or stent placement offers
no benefit over primary intervention in ST-elevation heart attack and
should not be used outside the context of randomised controlled trials.
Furthermore facilitated interventions with thrombolytic-based regimens
should be avoided." (Quote by e-mail; not in paper)

In an accompanying Comment Drs. Gregg Stone (Columbia University Medical
Center and the Cardiovascular Research Foundation, New York, NY, USA) and
Bernard Gersh (Mayo Clinic, Rochester, MN, USA) state: "The results of this
quantitative review are unequivocal and surprising: facilitated angioplasty
compared with primary angioplasty alone, rather than saving lives as
expected, results in an increase in mortality, along with greater rates of
reinfarction, urgent repeat revascularisation, major bleeding, haemorrhagic
stroke, and total stroke."

In a different trial (ASSENT-4), also published online today by The Lancet,
FransVan de Werf (Gasthuisberg University Hospital, Leuven, Belgium) and
colleagues looked at whether giving patients with ST-elevation heart attack
the drug tenecteplase (TNKase) before a delayed angioplasty/stent placement
would result in a better outcome than those receiving the delayed procedure
alone. They found that a strategy of full-dose tenecteplase was associated
with major adverse events when compared with angioplasty/stent placement
alone and cannot be recommended.

###

Contact: Dr Ellen C Keeley, University of Texas Southwestern Medical
Center, Division of Cardiology, 5323 Harry Hines Boulevard, Dallas, TX
75390, USA. T) 214 590 8617 Ellen.Keeley@xxxxxxxxxxxxxxxxxx

Professor Frans Van de Werf, Department of Cardiology, Gasthuisberg
University Hospital, Herestaat 49. B-3000 Leuven, Belgium. T) +32 16 34 34
71 frans.vandewerf@xxxxxxxxxxxxxxxxx Comment: Dr Gregg W Stone, Columbia
University Medical Center and the Cardiovascular Research Foundation, New
York, NY 10021, USA. T) 1-212-851-9304 gs2184@xxxxxxxxxxxx

Notes to editors:

*ST-elevation refers to elevated readings in an electrocardiogram.

**Angioplasty and stent placement are techniques that unblock narrowed
coronary arteries without surgery.

Contact: Joe Santangelo
j.santangelo@xxxxxxxxxxxx
Lancet


--------------------------------------------------------------------------------
- View the latest Cardiovascular/Cardiology News.
- View all the latest Medical News Headlines.
- Get the latest medical news in your email every week with our newsletter.
- View more information on heart attack.
- View more information on stroke.

http://www.medicalnewstoday.com
=========================end, and/or end quote================
-pluto
.

Relevant Pages

  • Re: heart attack survival, when alone (re-post)
    ... heart problems. ... vision - and then taught the proper coughing technique. ... particular doctor presented no proof that the patients even had an attack ... of a clot. ...
    (alt.gathering.rainbow)
  • Re: a reminder to all
    ... Short term, no argument, a T1 deep hypo is life-threatening. ... Why decide to risk either? ... You brought up the scenario after a heart attack has ...
    (alt.support.diabetes)
  • Re: to smoke or not to smoke a pipe
    ... the first thing to do would be to quit smoking immediately. ... thought at first, but looking back over my life, I stated smoking when I ... puzzled me, when I was in hospital recovering from my heart attack, was ...
    (alt.smokers.pipes)
  • Re: where r u
    ... Even through jokes, Yes, you guessed it, the Heart Attack has hit "The ... definitely waiting for the concrete to cure before the wall starts ...
    (rec.sport.paintball)