Angioplasty Info and the Stent, Part 4
Stent Treatment May Be Best Approach Even Hours After Heart Attack
- People who came to a hospital many hours after suffering a heart attack did better with invasive artery-opening treatment that included the implant of a stent than with clot-dissolving drug therapy.
- That's the conclusion of a new German study that might one day challenge current treatment guidelines.
- The amount of heart tissue destroyed by the heart attack was smaller in patients who got the invasive treatment, and they were also less likely to die, have a second heart attack or suffer a stroke than those given noninvasive clot-dissolving treatment, the researchers found.
- This finding increases the level of evidence in support of the invasive strategy and deserves consideration when current treatment guidelines for this category of patients will be reassessed, the report concluded.
- Current guidelines are based on previous studies that found that reopening arteries more than twelve hours after a heart attack is not effective because of damage already done to the blood vessel by a complete stoppage of blood flow.
- Many of the 365 patients in the German trial, all of whom were treated twelve to forty-eight hours after the heart attack began, did not suffer a total stoppage of blood flow.
- In this group, fifty percent of the patients had some blood flow in the blocked artery.
- In the group that had a totally blocked artery, half of them had blood flow coming in from collateral vessels.
- It is believed by some scientists that the German trial results were a noteworthy challenge to existing dogma and an important contribution to current knowledge; however, the results do not yet justify a revolution in clinical practice.
- Other studies now under way may decide whether such a revolution is justified.
- At least one major study is trying to determine whether invasive artery-opening treatment is justified when patients show up many hours after a heart attack.
- The real message of the German study is the need for earlier detection and treatment of heart attacks.
- Studies have shown that up to forty percent of people who have a heart attack do not go for treatment quickly because they do not recognize the symptoms.
- If we really want to increase the benefits of treatment, early symptom recognition and early opening of the artery still holds the greatest promise.
Drug-Eluting Stents Work for Restenosis
- Drug-eluting stents greatly reduce the risk that arteries will renarrow in patients with in-stent restinosis or artery narrowing caused by scar tissue.
- The study noted that plaque-clogged arteries that are opened with a regular metal stent have a 1-in-3 chance of becoming narrowed again with scar tissue (restinosis).
- If this problem is treated using a metal stent or balloon angioplasty, the artery will narrow again in half the patients.
- This study of 77 patients found a 13 percent rate of repeat in-stent restinosis among patients treated with a drug-eluting stent that slowly releases the drug sirolimus, which prevents formation of scar tissue.
- The in-stent restinosis repeat rate was 61 percent for patients treated with balloon angioplasty.
- At the nine-month follow up, 14 percent of the patients treated with the sirolimus-eluting stent required yet another procedure to open the artery, compared with 32 percent of balloon angioplasty patients.
- Restinosis was dramatically lowered by drug-eluting stents as opposed to balloon angioplasty alone, and that resulted in a dramatic lowering in the major adverse cardiac event rate.
There is more information about angioplasty; as well as, the stent at the following links:
Angioplasty Info and the Stent, Part 1
Angioplasty Info and the Stent, Part 2
Angioplasty Info and the Stent, Part 3
Angioplasty Info and the Stent, Part 5
Angioplasty Info and the Stent, Part 6
Angioplasty Info and the Stent, Part 7