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According to the American Heart Association, over a million Percutaneous Transluminal Coronary Angioplasty (PTCA) procedures are performed in the US each year to treat coronary artery disease (CAD). That may sound like PTCA is widely available but, in fact, it is not offered at all hospitals. Instead, patients with heart attacks (also known as myocardial infarctions, or MIs) are given so-called "clot buster" drugs.
Does it matter if a person suffering an MI receives a "clot buster", or thrombolytic, drug or angioplasty? The answer is a resounding yes. "Numerous studies have shown that treatment of serious heart attacks with angioplasty is preferable to thrombolytic therapy," says Douglas C. Morris, MD, Director of The Emory Heart & Vascular Center.
The most common kind of heart attack is triggered by a blood clot that blocks blood flow in a coronary artery and produces an abnormal electrocardiogram (EKG). When a cardiologist sees this ST-segment elevation on the EKG, he or she knows a serious heart attack is underway. If coronary blood flow is restored to normal as quickly as possible, it may prevent as much permanent damage to the heart as possible.
PTCA, a minimally invasive procedure, uses a balloon-tipped catheter to enlarge a narrowing caused by atherosclerosis in a coronary artery. As the balloon is inflated, the vessel opens further allowing for improved flow of blood and reducing the risk of heart attack and sudden death. In fact, angioplasty performed at the time someone is suffering a serious heart attack (also called a myocardial infarction, or MI) can actually help prevent permanent damage to the heart muscle and greatly improve survival odds.
About half of patients treated with "clot busters" continue to have a significant blockage and reduced blood flow in the affected artery. But in over 90 percent of heart attack patients treated with angioplasty, blood flow is brisk and no or only mild blockage remains. The relative death rate among patients treated with angioplasty is 60 percent lower than the death rate among similar patients treated with "clot buster" therapy (4.4 percent compared to 6.5 percent). In addition, the probability that an artery opened with "clot buster" therapy alone will remain open at six months is 59 percent while angioplasty improves the odds improve to 87-91 percent at three to six months.
"Unfortunately, almost two-thirds of heart attack patients in this country present to hospitals where angioplasty isn't offered," notes Dr. Morris. He urges people to find out what hospitals in their areas do offer angioplasty so they will be prepared if faced with making a decision about where they — or a loved one — should be transported for treatment of a heart attack. The Emergency Departments at both Emory University Hospital (EUH) and Emory Crawford Long Hospital routinely quickly prepare heart attack patients with ST-segment elevation for angioplasty performed by Emory's team of highly experienced interventional cardiologists. EUH is the only hospital in Dekalb County that provides angioplasty.
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