Study Shows Early Intervention Can
Help Save Sickest Heart Attack Patients
Clinical Trial Led by St. Lukeís-Roosevelt Researcher Judith Hochman, MD
Many of the sickest patients with heart attacks may benefit from aggressive therapy at an
early stage, according to a new study led by Dr. Judith Hochman of St. Lukeís-Roosevelt
Hospital Center and Columbia University and presented today at the American College of Cardiologists conference
in New Orleans. In the clinical trial, 302 patients with severe
heart attacks leading to cardiogenic shock (which produces a dramatic decline in blood
pressure and in the flow of blood to the vital organs and which historically is associated
with an 80-90% mortality rate) were randomly assigned either to intensive medical
treatment with balloon pumps and clot-busting drugs, or to immediate balloon angioplasty
or coronary artery bypass surgery; the group receiving the angioplasties or bypasses
experienced a significantly lower mortality rate in preliminary six month results. Dr.
Hochmanís study was conducted in collaboration with The New England Research
Institutes and investigators at 30 medical centers in the U.S. and abroad, and was
supported by the National Heart, Lung, and Blood Institute of the National Institutes of
Health.
"The findings of this study provide, for the first time, a rational basis for physicians to select the best
course of treatment for patients with the most severe heart attacks, which may include angioplasty or open heart
surgery soon after arrival in an emergency department," said Dr. Hochman. "Because almost 85% of patients
first go to hospitals without angioplasty or heart surgery facilities, these findings can guide physicians
to determine which patients can be managed locally with a device to support the
circulation and with bloodclot-busting thrombolytic drugs, and for which the risks of
transfer to another hospital are outweighed by large potential benefit," concluded Dr.
Hochman.
The study showed that the 30-day mortality rate in the surgical/angioplasty group was
46%, and in the intensive medical treatment group 55%. In addition, noted Dr. Hochman
and her colleagues, the comparative benefit of the bypass surgery/angioplasty increased
over time; preliminary six month results demonstrate significantly fewer deaths among
patients under 75 receiving the early angioplasty or surgery, with a 49% mortality rate
compared to the 70% mortality rate for those under 75 who were treated with intensive
medical therapy alone. Researchers cautioned, however, that the overall difference
between the two treatments was less than expected and not statistically significant at 30
days.