Improvements in angioplasty in the last few years have made the procedure for unblocking coronary arteries much safer, allowing cardiologists to perform procedures they were reluctant to do in the past.
The procedures include performing angioplasty after clot-busting drugs have been given and using it in hospitals that don't have a heart surgery team available for emergencies, researchers said during a weekend cardiology meeting in Chicago.
The net effect is that angioplasty, which is generally considered to be much more effective than drugs for treating heart attacks, should be available to many more patients, researchers said.
The findings "really could change practice and open up opportunities for patients to get more optimal treatment," said Dr. Bonnie Weiner of St. Vincent Hospital in Worcester, Mass., president of the Society for Cardiovascular Angiography and Interventions.
More than 75% of hospitals in the U.S. do not routinely perform angioplasty, also known as percutaneous coronary intervention -- most because they do not have heart surgeons on staff to make repairs if the procedure punctures an artery or causes some other damage.
When patients arrive at such a hospital after a heart attack, the only choice is to administer clot-busting drugs within the 90-minute "golden window" in which treatment is most effective.
Once such therapy has been administered, cardiologists have been reluctant to transfer patients to another hospital to undergo angioplasty out of fear that the procedure would cause excess bleeding and endanger their lives.
The fear now appears to be groundless and counterproductive, Dr. Warren J. Cantor of the Southlake Regional Health Centre in Newmarket, Ontario, Canada, reported Sunday at a meeting of the American College of Cardiology and the Society for Cardiovascular Angiography and Interventions.
Cantor reported on 1,010 patients who suffered a moderate or severe heart attack and sought treatment at hospitals that could not perform angioplasty.
All were given the second-generation clot-busting drug tenecteplase, which has fewer problems than older drugs. Half were then transferred to another hospital to receive angioplasty within six hours; the other half were given conventional medical treatment.
Cantor said the results were dramatic.
Overall, 16.6% of patients who received only drugs suffered another heart attack, severe chest pains or died in the 30 days after the procedure, compared with 10.6% of those who received prompt angioplasty. That was a 46% reduction.
