Surgical intervention, such as angioplasty, clearly has a role in the early treatment of heart attack, said Dr. David J. Maron, associate professor of medicine and emergency medicine at Vanderbilt University, and co-author of an accompanying editorial in the journal. The new report covered survival only after the first 30 days of a heart attack, he noted.
"We know that PCI [percutaneous coronary intervention, or angioplasty] improves survival in the acute phase of a heart attack," Maron said. "The best short-term therapy is reperfusion, preferably with PCI. As a complement to that, there needs to be long-term therapy for atherosclerosis."
Reperfusion is restoration of blood flow to the heart. Atherosclerosis is the artery-hardening process that leads to blockage of blood vessels.
Setoguchi agreed. A separate analysis of in-hospital deaths in the group of patients studied showed that "increased use of PCI might have explained the improvement in short-term mortality," she said.
Dr. William E. Boden, professor of medicine and public health at the State University of New York at Buffalo, called the study valuable, even though it had limitations. For instance, it only included residents of two states and left out data on survival in the first 30 days after a heart attack, he said.
"But I don't think those limits invalidate the study," Boden said. "This is a very important observation, because we tend to under-treat the elderly. Often we intuit that these medications are too little, too late, so why bother. The study stresses that these are higher-risk patients, and medications should be used as aggressively in older patients as in younger patients."
The U.S. National Heart, Lung, and Blood Institute describes medications used to pr
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