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October 23, 2000
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American Heart Association journal report: Angioplasty and stenting can aid worst heart attacks
DALLAS, Oct. 24 -- Heart attack patients with high levels of cardiac troponins -- an indicator of heart damage -- benefit when treated with angioplasty plus stenting, whereas those with lower levels of the protein may not need the procedures, according to research published today in Circulation: Journal of the American Heart Association.
Angioplasty is a procedure in which a balloon is inflated in an artery to unclog it and increase blood flow. A stent is a mesh tube used to keep the artery open after angioplasty.
"Quick treatment with angioplasty plus stenting can help heart attack patients survive if they have high levels of troponin," says Evangelos Giannitsis, M.D., principal investigator and senior physician at the Medical University of Lubeck in Lubeck, Germany. He works in the research group of Hugo A. Katus, M.D., who developed and patented the troponin assay.
Cardiac troponins (cTnT) are an indicator of the level of heart muscle damage. Patients with higher levels of the protein have higher death rates in general and longer stay in intensive care units.
In the study, 85 percent of patients with high cTnT levels who received angioplasty and stents avoided a second heart attack and did not need additional angioplasty during a follow-up period of approximately three years. Of those with lower cTnT readings, 78 percent did not have a second heart attack or need more angioplasty.
Angioplasty alone was less successful in the patients with elevated cTnT than in patients with low cTnT. But when stenting was added, death rates were reduced.
The study supports previous research from other teams that found the cTnT levels are a valuable risk indicator and may help determine which patients will benefit from stenting.
"We can say that in our study, these patients seem to benefit from a more aggressive mechanical intervention," Giannitsis says.
Currently in the United States, it is recommended that angioplasty be limited to institutions that have an experienced cardiovascular surgical team available as backup for all balloon procedures. Many U.S. hospitals administer clot-busters, such as TPA for emergency treatment of heart attacks and do not have the facilities or staff to perform emergency angioplasty.
The German researchers examined blood samples from 159 patients with inferior acute heart attack - which refers to the location of the heart damage - and who also showed heart rhythm abnormalities on an electrocardiogram (ECG). Of these, 93 had excessively elevated cTnT. Primary coronary angioplasty was performed on nearly all the patients, and about half the total group received stents as well.
Several trials are underway to investigate the possible benefits of combining clot busting drugs with stenting for heart attack patients with elevated cardiac troponin, he says.
The message is clear, says Giannitsis. "Men and women with symptoms of heart attack "should seek hospital admission as soon as possible," he urges. "When they arrive early, the amount of damage to the heart is smaller. The more time you lose, the more extensive the damage."
Co-authors of the study are Stephanie Lehrke, M.D.; Uwe K.H. Wiegand, M.D.; Volkhard Kurowski, M.D.; Margit Muller-Bardorff, M.D.; Britta Weidtmann, M.D.; Gert Richardt, M.D.; and Hugo A. Katus, M.D.
Media Advisory: Dr. Giannitsis can be reached from the United States by phone at 49-451-500-2501; or by fax 49-451-500-6437. (Please do not publish these numbers.)