Better Outcomes for Treatment Received Immediately: Heart Attack Patients

Better Outcomes for Treatment Received Immediately: Heart Attack Patients

Authored by DesiMD Doctor on 2 Jan 2016 - 12:24


According to the latest study published in the Journal of the American College of Cardiology (JACC), delay in recognizing their heart attack symptoms can lead to increased risk for patient’s life. The study recommends heart attack patients to seek immediate treatment on experiencing symptoms.

According to the American Heart Association (AHA) the easy way to remember some signs of stroke are: F.A.S.T:

F: Face Drooping – One side of the face drooping or numb, uneven smile
A: Arm Weakness – One arm weak or numb, one arm drifting downward
S: Speech Difficulty –Slurred speech, unable to speak or hard to understand; Unable to repeat a simple sentence.
T: Time to call Hospital for Ambulance – If the person shows any of the above referred symptoms, even if the symptoms go away, rush to the hospital. Note the time when the first symptoms appeared.

Dr. Michael A. Kutcher, Wake Forest Baptist Medical Center, says patients with longer door-to-balloon time are a high-risk group and should be treated accordingly. Door-to-balloon (D2B) time starts when a heart attack patient enters the emergency room till percutaneous (medication applied directly to the skin) coronary intervention is executed to reinstate the blood flow. According to AHA, STEMI-(segment elevation myocardial infarction) is a type of heart attack, which is caused due to extended period of blocked blood supply that affects an important part of the heart muscle. 

AHA and American College of Cardiology (ACC) guidelines mention that hospitals who deal with STEMI patients with emergency percutaneous coronary intervention, should execute the treatment within or less than 1.5 hours.

In 2006, ACC established the D2B alliance in order to diminish the time to which STEMI patients incur percutaneous coronary intervention. In nearly 90 percent of percutaneous coronary intervention situations, blood flow is reinstated on the surface of the heart, however in 1 out of 3 patients, the blood flow is not reinstated to the heart muscle.

Research Study: Researchers looked into the records of about 2060 patients in order to compare the effect upon heart muscle function of the time from commencement until treatment, with time from D2B -  meaning between reaching at the emergency department till the treatment is completed.

In the multi-center, the team harmonized the results with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial and compared the patients with symptoms in three categories: within or less than 2 hours, between 2 to 4 hours, over 4 hours.

Study findings: As compared with the patients who were treated more promptly, researchers found that those who incurred treatment with a balloon angioplasty to reinstate blood flow to the heart after 2 to 4 hours or longer from the beginning of symptoms were less liable to have complete blood flow reinstate to the heart muscle and also more liable to die within 3 years.

Lead author of the study Dr. Roxana Mehran, says, "The decrease in median door-to-balloon time in recent years has not resulted in a reduction in mortality in STEMI patients. This study highlights the need to reconsider the role of door-to-balloon as a performance metric and examine the utility of a broader metric of systems delay such as first medical contact to balloon time as well as total ischemic time."

In a subsequent editorial, Dr. Michael A. Kutcher, from Wake Forest Baptist Medical Center said that the D2B metric and systems in place are highly important and should proceed. On the other hand, he indicates the physicians to understand the signs and symptoms of the beginning of ischemia, which is the loss of blood flow.


Referfence:Effect of ischemia duration and door-to-balloon time on myocardial perfusion in ST-segment elevation myocardial infarction: an analysis from HORIZONS-AMI trial (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction), Abhiram Prasad et al., JACC: Cardiovascular Interventions, doi:10.1016/j.jcin.2015.08.031, published 28 December 2015, abstract;  American College of Cardiology news release, accessed 23 December 2015.


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