With Angioplasty, More Is Better

WEDNESDAY Nov. 12, 2008 -- Heart attack patients who undergo emergency coronary angioplasty at community hospitals are more likely to survive if they're treated at facilities that do more than 83 such procedures a year, researchers report.

In angioplasty, a thin tube is inserted into blood vessels and used to inflate a tiny balloon that widens arteries blocked or narrowed with cholesterol-laden plaque to restore blood flow to the heart. A stent is often put in place to keep the blood vessel open.

The Johns Hopkins researchers analyzed data on 5,737 male and female heart attack patients who had emergency, so-called primary angioplasty at 31 U.S. community hospitals with no on-site cardiac surgery backup. The analysis showed that patients treated at hospitals that performed 83 or more emergency angioplasty procedures a year had the lowest death rate (2.2 percent), while those treated at hospitals that did no more than 46 procedures a year had a death rate of 4 percent.

The study was to be presented Wednesday at the American Heart Association's annual scientific sessions, in New Orleans.

"The results reinforce what we have known for a long time with many other technical procedures, such as organ transplantation or specialized heart surgery: From an institutional and physician perspective, the more procedures performed, the better the outcomes for the patient," senior study investigator and interventional cardiologist Dr. Thomas Aversano said in an AHA news release.

He and his colleagues said their findings suggest that the safety and survival rates of patients undergoing emergency angioplasty could be improved by easing restrictions on the use of elective angioplasty so that doctors and nurses at hospitals with no elective angioplasty programs can get more experience.

Currently, AHA and American College of Cardiology guidelines limit community hospitals' use of angioplasty to emergency situations. In all other cases, patients must be transferred to another hospital that has on-site, specialized heart surgery backup, the news release said.

In 2005, about 1.3 million angioplasty procedures were performed on 640,000 Americans, a 324 percent increase since 1987, according to the AHA.

More information

The U.S. National Heart, Lung, and Blood Institute has more about angioplasty.

Posted: November 2008


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