Guidelines of the American Heart Association and American College of Cardiology recommend the quick angioplasty strategy, but "the evidence for it was fairly limited until recently," Cantor said. "Older studies said there might be more harm than good, with major bleeding."
"That was true back then, but we are talking about a generation ago," said Dr. Jeffrey W. Moses, director of the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center. "With stents and drugs like Plavix, the world has changed."
Stents are flexible metal tubes inserted to keep arteries open following angioplasty, and Plavix is a potent clot-dissolving drug.
Several studies have compared clot-dissolving therapy with angioplasty in the hours after a heart attack, "and angioplasty is better," Moses said. While statistics are vague, probably only half the people who suffer heart attacks in the United States get angioplasty as the first treatment, he said.
"If you get clot-busters, you should have angioplasty as soon as possible, at that site or somewhere else," Moses said.
The case for limiting heart attack treatment to clot-dissolving therapy has been lost, Cantor said.
"Recent studies using contemporary equipment suggested a much safer and effective treatment, and we confirm it in the largest trial yet done," he said.
Symptoms indicating need for emergency heart attack treatment are described by the American Heart Association.
SOURCES: Warren J. Cantor, M.D., assistant professor, medicine, University of Toronto; Jeffrey W. Moses,
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