Study: Angioplasty Can Beat Drug

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<SMALL><I>By LINDSEY TANNER, AP Medical Writer</I></SMALL>

CHICAGO (AP) - When it comes to saving heart attack patients'

lives, angioplasty beats clot-busting drugs, but only if done in

hospitals that specialize in the procedure, new research suggests.

In hospitals with a low number of angioplasties, patients who

had one died at about the same rate as those given clot-dissolving

drugs, according to a study that looked at 62,299 heart attack

patients.

At hospitals with high numbers of angioplasties, the in-hospital

death rate was significantly lower in the 11,733 angioplasty

patients - 3.4 percent versus 5.4 percent for 8,605 patients

treated with clot-busters.

Whether one treatment is better than the other has been debated

in previous research.

" This study may provide an explanation for the discordant

results of previous studies, " the researchers wrote in Wednesday's

Journal of the American Medical Association.

Dr. Magid, an emergency room physician for Kaiser

Permanente in Denver who led the study, said hospitals that perform

a lot of angioplasties are able to identify patients who need one

and get it done faster.

Dr. Faxon, president-elect of the American Heart

Association, said the consensus among heart specialists is that

angioplasty is superior " when done in the right setting, " and the

new findings support that.

Both treatments have the same goal - to clear an artery blockage

that deprives the heart of oxygen. In angioplasty, a balloon-tip

catheter is threaded into the artery to open it. Clot-dissolving

drugs are given intravenously.

Emergency angioplasty is performed in up to 80 percent of heart

attack patients eligible for either type of treatment. It is

generally believed to be more effective at opening a clogged

artery, but requires more skill. Quick treatment, within 12 hours

of symptoms, is required for both to be effective.

About 700,000 angioplasties are performed nationwide each year.

That includes emergency angioplasties as well as elective ones,

which are not done during a heart attack.

In the study, which involved 446 hospitals, high-volume centers

were those that did at least 49 emergency angioplasties a year.

Low-volume centers performed 16 or fewer.

Another study in the journal found that Medicare patients

undergoing elective angioplasties and stent implants at high-volume

hospitals had better 30-day survival rates and were less likely to

need immediate heart bypass surgery than those treated at

low-volume hospitals.

Studies done before the use of stents - small wire scaffold-like

devices that are inserted into arteries to prop them open - found

similar results, and Faxon said the new findings are not

surprising.

The American College of Cardiology recommends that elective

angioplasties be done by a doctor who has performed at least 75 of

them and at hospitals that do at least 400 annually.

As for emergency angioplasties, the college and American Heart

Association generally recommend that they be done at high-volume

centers.

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On the Web:

<A HREF=http://jama.ama-assn.org>http://<A

HREF=http://jama.ama-assn.org>jama.ama-assn.org</A></A>

<A HREF=http://www.americanheart.org>http://<A

HREF=http://www.americanheart.org>www.americanheart.org</A></A>