Heart attack deaths down sharply

The study found "remarkable improvements" in the care of heart attack victims in all 14 countries studied, said Dr. Gregg C. Fonarow of UCLA's David Geffen School of Medicine, who was not involved in the research.

"It is not simple to manage these patients. Many therapies need to be applied very rapidly," he said. This study shows that individual drugs and treatments that have been validated in clinical trials can be combined in the real world to produce "very meaningful benefits."

Added Dr. Keith A.A. Fox of the University of Edinburgh in Scotland, who led the study, published in the Journal of the American Medical Assn.: "Our study supports the fact that hospitals are using new treatments effectively."

For every 1,000 patients hospitalized with heart conditions, he said, there were 39 fewer deaths and 90 fewer patients with new heart failures compared with seven years ago. In the United States, with as many as 5 million such patients each year, that would translate to nearly 200,000 fewer deaths if all hospitals were following the treatment guidelines.

"There have been a lot of lives saved, a lot of complications averted," said Dr. Joel M. Gore of the University of Massachusetts Medical School, another of the study's leaders.

The researchers could not attribute the improvements to any one treatment or medication, concluding that it was the combination that was responsible.

The improvements included a doubling in the use of balloon angioplasty to clear blocked arteries and increased use of old and new drugs, such as aspirin, cholesterol-lowering statins, anti-clotting drugs called glycoprotein IIb/IIIa inhibitors, blood thinners such as clopidogrel and low-molecular-weight heparin, and blood-pressure-reducing drugs such as ACE inhibitors.

There was also "a marked reduction in the use of ineffective medications," Gore said, including clot-dissolving enzymes, calcium channel blockers and unfractionated heparin.

The study, known as the Global Registry of Acute Coronary Events, or GRACE, included 44,372 patients at 113 hospitals from 1999 to 2006. All patients had either suffered a severe heart attack or suffered from acute coronary syndrome, which includes other types of heart attacks and a kind of chest pain called unstable angina.