HealthLINK: Cardiac: Heart attack patients do better at hospitals specializing in angioplasty

Can we help?

Follow up on this month's He@lthLINK

Phone Numbers

Directory assistance
(203) 688-4242

Patient information
(203) 688-4177

Adult emergency
(203) 688-2222

Children's emergency
(203) 688-3333

Admitting
(203) 688-2221

Children's admitting
(203) 688-3331

Psychiatric admitting
(203) 688-9907

Mailing address:
Yale-New Haven Hospital
20 York Street
New Haven, CT
06510-3202

April 2006

News this month
Heart attack patients do better at hospitals specializing in angioplasty

Studies have shown that the
artery-opening procedure called angioplasty is the best emergency treatment for a common type of heart attack, if delivered in a timely way. And a new study by Yale and Michigan universities, published in the January 17, 2006 issue of Circulation, a journal of the American Heart Association, concludes that angioplasty is most effective when performed in hospitals that make it the first-line treatment for these heart attacks, rather than at centers where it is not the leading form of heart attack care.

Angioplasty is most effective when performed in hospitals that make it the first-line treatment for common heart attacks.

Emergency angioplasty – or primary percutaneous coronary intervention (PPCI) – has the biggest impact if it is performed within 90 minutes of a patient’s arrival at the emergency room door, consistent with recommendations from national guidelines.

National study examines 37,000 patients

The study was funded by a National Heart, Lung and Blood Institute grant led by Harlan Krumholz, MD, director of the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital and the Hines Professor of Medicine at Yale University School of Medicine. The study included data on more than 37,000 people given emergency treatment for heart attacks at 463 American hospitals.

The study showed that patients treated with angioplasty in hospitals that did not predominately focus on angioplasty had a higher risk of death. Moreover, patients in those hospitals had to wait longer for treatment – an average of 20 vital minutes – and had a higher likelihood of being treated beyond the recommended 90-minute window after the attack.

"Committing to angioplasty as first-line therapy leads to faster treatment, perhaps the most critical element for a heart attack patient."

"In the case of emergency angioplasty, for hospitals it seems that it’s not just how many you do, but how used to doing them you are,” says lead author Brahmajee Nallamothu, MD, MPH, an assistant professor of internal medicine at the University of Michigan Medical School. “Committing to angioplasty as first-line therapy leads to faster treatment, perhaps the most critical element for a heart attack patient."

The finding shouldn’t change the action of anyone having a heart attack, or people who think that someone they know may be having a heart attack, Nallamothu said. Hospitals not equipped for
round-the-clock angioplasty should work on optimizing their clot-dissolving therapy, or determine better ways to institute emergency angioplasty measures, the report said.

Physician Referral Online

A free and confidential service
of Yale-New Haven Hospital.

Physician Referral Online
Using your own criteria, you can request information from a database of 900 area physicians who have registered to participate.

Request an appointment
We would be happy to assist you in scheduling an appointment with a member of the hospital's medical staff. Use the link above or call:

203-688-2000
or toll free
1-888-700-6543
to talk with a referral coordinator.

Angioplasty is the best treatment for a certain type of heart attack

Rapid treatment of heart attacks saves lives. If done quickly, angioplasty is the best treatment for a certain type of heart attack. During angioplasty, interventional cardiologists first thread a tiny balloon-tipped catheter into the blocked vessel. They then restore blood flow by inflating the balloon, which flattens built-up plaque against the vessel wall. Usually a small piece of metal called a stent is inserted to prop open the artery.

“The average “door-to-balloon” time – from when the patient enters Yale-New Haven’s ED to the moment that the artery is cleared by balloon dilation in the catheterization lab — is 85 minutes, well within the American Heart Association’s recommended standard of 90 minutes.”

In Yale-New Haven Hospital’s Emergency Department, our treatment of acute MI [myocardial infarction, or destruction of heart tissue resulting from obstruction of the blood supply to the heart muscle] is 100 percent geared toward getting the patient and the catheterization lab team together as quickly as possible. We made the decision years ago that we would rely on angioplasty, 24 hours a day, seven days a week, as our reperfusion [opening blocked arteries] strategy and have designed our systems around that goal. The average “door-to-balloon” time – from when the patient enters Yale-New Haven’s ED to the moment that the artery is cleared by balloon dilation in the catheterization lab — is 85 minutes, well within the American Heart Association’s recommended standard of 90 minutes.

Acheiving treatment in under 90 minutes
To achieve the treatment goal of less than 90 minutes (no more than 50 minutes in the ED and 40 minutes to perform the angioplasty) we follow a strict protocol that assures rapid diagnosis and transport to the catheterization lab for this lifesaving procedure.

The triage nurses are critical to our program’s success as they make the initial assessment and initiate the heart attack protocol. We pay attention to the full gamut of heart attack symptoms, not just chest pain. Once the diagnosis is made by our senior ED physician – within 20 minutes of ED arrival – our well-orchestrated ED and cardiac team efficiently manages patients to assure their hearts have blood flow restored as quickly as possible.

"Hospitals that commit to angioplasty as their main treatment strategy do best by their patients.”

This study indicates that among hospitals that have the capability of providing angioplasty, those that commit to angioplasty as their main treatment strategy do best by their patients. We speculate that these hospitals have developed protocols that improve their ability to deliver rapid and effective care. We found that the focus on angioplasty was more important than how many of these procedures that they performed.

Cardiologist Henry Cabin, MD, is the medical director of the Yale-New Haven Hospital Heart Center, director of the Yale-New Haven Hospital Coronary Care Unit and associate chairman of the department of Internal Medicine at Yale University School of Medicine.