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Cardiovascular

Since the 1990s, HealthLINK has been providing Yale-New Haven patients with informative and cutting-edge information as our experts comment on news ranging from teething to heart failure. HealthLINK: Cardiovascular considers issues from many heart-related disciplines that have bearing on the way all of us we eat, sleep, work and exercise.

HL_cardiovascular0910

September 2010

New study confirms that drug-eluting stents
are safe and effective

Percutaneous coronary intervention (PCI), also referred to as coronary angioplasty, is the gold standard treatment for an acute myocardial infarction (MI) or heart attack. This procedure restores blood flow through an occluded vessel to the heart muscle. Studies reveal that time is muscle — the sooner the artery is opened, the less permanent damage that occurs, and the better both the short- and long-term outcomes are. Angioplasty is also a very powerful tool in treating angina that may not occur in the setting of a heart attack.

What the news
means to you

Time is still of the essence in heart attack treatment, says YNHH's
Glen Henry, MD
.

Angioplasty is a procedure that inserts a balloon-tipped catheter through an artery in the groin or arm/wrist up to the area of arterial blockage. Then the very small balloon is inflated to a diameter around a 1/8 inch to re-open a pathway for blood flow. Angioplasty is durable and far less invasive than bypass surgery, and therefore is the procedure of choice among cardiologists for many patients.

Over the years, many improvements have occurred in PCI. There have been numerous refinements in equipment, and the procedure is frequently now done through an incision less than 3/8 of an inch. The most significant evolution of PCI was the development of the stent in the late 90's. A stent is a very small, expandable slotted metal tube that is expanded into the wall over the balloon to keep the artery open both short and long term. Short term, it prevents the artery from immediately re-narrowing due to elastic recoil. Long-term benefits come from stretching the artery larger, thereby preventing re-narrowing, or restensosis, from the ingrowth of scar tissue. The ultimate goal of this procedure is to restore normal blood flow to the heart muscle (revascularization).

Further progress occurred April 2003 when the U.S. Food and Drug Administration (FDA) approved the first drug-eluting stent - a stent covered with medication - to significantly reduce the rate of re-blockage that occurs with existing stents and angioplasty procedures. However, questions remained about their long-term safety and/or effectiveness.

In a recent study published in the September issue of Catheterization and Cardiovascular Interventions, researchers at the Rabin Medical Center in Israel concluded that the use of drug-eluting stents (DES) improve the long-term clinical outcomes for patients undergoing angioplasty.

Researchers evaluated 2,633 consecutive patients undergoing percutaneous coronary intervention between 2004 and 2008 who received DES and 3,950 patients who received bare-metal stents (BMS). Results over an average of three years showed that use of DES compared with BMS reduced the occurrence of heart attack, and the need for symptom-driven repeat stenting for restenosis. Death and MI was significantly lower in the DES group, showing a persistent benefit of DES over time.

"The main effect of DES is reduced restenosis (a narrowing of the blood vessels), which is evident in our analysis," said Tamir Bental, MD, lead author. "This outcome was sustained over time and could certainly be a major factor contributing to the survival benefit of DES." In addition, patients receiving DES had more complete revascularization.

In treating a heart attack, every minute counts to save heart muscle from permanent damage and prevent unnecessary deaths. For every 15 minutes that passes before angioplasty, an estimated six of 1,000 heart attack patients die. Unfortunately, less than 15 percent of U.S. hospitals consistently perform emergent PCI in less than 90 minutes from the time of presentation.



What the news means to you

An acute coronary syndrome occurs when a sudden blockage in a coronary artery greatly reduces or cuts off the blood supply to an area of the heart muscle causing an MI. Once heart cells are dead, they muscle does not regenerate. Thus, the initial treatment goal is to open the artery as quickly as possible to limit damage.

Primary angioplasty is a procedure that opens a blocked coronary artery during a heart attack. This achievement is the result of an exceptional team of cardiologists, emergency medicine physicians, nurses, technologists and others who work tirelessly to provide the best care and results for patients who suffer a heart attack. At Yale-New Haven Hospital, treatment of an acute myocardial infarction (MI) is strategically geared to get the patient and catheterization lab team together as quickly as possible.

Research shows that if a patient's blocked artery can be opened within 90 minutes of arriving at the hospital, the risk of dying is reduced by 40 percent. Known as the door-to-balloon time (D2B), it is a performance of the time measure between patient entrance in the emergency department and when angioplasty is performed. Yale-New Haven's median D2B time is 68 minutes, significantly improving on the American Heart Association's recommended standard of 90 minutes.

Acute coronary syndromes are medical emergencies. Half of deaths due to a heart attack occur in the first 3 or 4 hours after symptoms begin. The sooner treatment begins, the better the chances of survival. Anyone having symptoms that might indicate an acute coronary syndrome should obtain prompt medical attention. Prompt transportation to a hospital's emergency department by an ambulance with trained personnel may save the person's life. 

Learn more about Yale-New Haven Hospital's Heart and Vascular Services.

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