Clearing more arteries works in angioplasty trial

Heart attack patients who undergo angioplasty for a clogged artery that caused the attack may do better if other clogged arteries are done at the same time, new research suggests. Patients who had multiple coronary arteries opened with angioplasty techniques during emergency surgery were 65 percent less likely to die, have a repeat heart attack or chest pains known as angina during the follow-up period than those who only had the so-called "culprit artery" opened. The randomized trial of 465 patients in Britain was halted early, in January 2013, when the results in the group in which multiple arteries were opened became evident, the researchers reported. The study was published online September 1 in the New England Journal of Medicine to coincide with presentation of the results at the European Society of Cardiology 2013 Congress in Amsterdam

Study sees lower death risk with bypass surgery versus angioplasty for older heart patients

Older patients with clogged heart arteries may have a little lower death risk over time if they get bypass operations instead of angioplasty and stents to fix the problem, new research suggests. It's not the kind of study that gives conclusive evidence, but doctors say it gives a "real world" look at how people fare in ordinary practice. As such, it could tip the balance toward surgery for patients considering the choice, especially because research already shows bypass gives a better and longer lasting result for people with multiple blockages. In a bypass operation, doctors move healthy blood vessels from other parts of the body to detour around clogged arteries supplying blood to the heart. Angioplasty treats the problem via a tube pushed through a blood vessel. A tiny balloon is inflated to flatten the clog and a mesh scaffold, a stent, is placed to prop the artery open. Researchers compared these approaches using records on 190,000 Medicare patients with two or three blockages - the largest study ever of this issue. Death rates were similar one year after either treatment. But after four years, nearly 21 percent of the angioplasty patients had died versus about 16 percent of those who had bypass surgery. Results were discussed at an American College of Cardiology conference in Chicago and published online by the New England Journal of Medicine

Angioplasty and heart stents overused by many cardiologists: study

About 15 percent of all cardiac stent implants and angioplasty procedures are probably unnecessary, according to the findings of a new study by U.S. researchers. The findings were published this week in the Journal of the American Heart Association, and come at a time when federal investigators in several states are looking into allegations that some doctors performed unnecessary heart stent implant procedures for financial gain. However, the problems with inappropriate heart stents and angioplasty procedures likely extends beyond just a few rogue doctors. Heart stents and angioplasty are procedures meant to prevent heart attacks and other cardiovascular problems in patients with clogged arteries. The procedures are collectively known as percutaneous coronary intervention (PCI)

Cardiac rehab can boost survival after angioplasty, study finds

Patients who undergo angioplasty to unblock a clogged artery have better odds of survival if they participate in a cardiac rehabilitation program afterwards, researchers report. The findings, published May 16 in Circulation, are significant given the fact that more than 600,000 angioplasties are performed in the United States each year, according to the American Heart Association (AHA). In the 14-year analysis, researchers examined the outcomes for nearly 2,400 patients who underwent percutaneous coronary interventions (PCI), commonly known as angioplasties. The study found that 44 percent of the patients had participated in at least one session of a cardiac rehabilitation program, which typically includes patient education, customized exercise programs, nutrition counseling, assistance in quitting smoking, weight control therapy and medical evaluations to track patient progress. Overall, researchers discovered a 46 percent relative reduction in death from all causes in patients who participated in a rehab program following an angioplasty

Cath Lab of the Future: angioplasty, stents, robots and more

A half century ago, Dr. Mason Sones, working in his cath lab, discovered that he could inject contrast dye selectively into the coronary arteries. His discovery revealed in great detail the anatomic nature of coronary artery disease and, within a very short time, led to the treatments of both bypass graft surgery and angioplasty. Along with Dr. Melvin Judkins, Sones founded an organization dedicated to excellence in imaging and diagnosis of heart disease: the Society for Cardiovascular Angiography and Interventions (SCAI). This month, SCAI has published a paper forecasting what the cath lab of the future might look like. The paper, titled "The Catheterization Laboratory and Interventional Vascular Suite of the Future: Anticipating Innovations in Design and Function," appears in the current issue of Catheterization and Cardiovascular Interventions. It features predictions on the future of these medical spaces, including advances in technology and design as well as changes in function, staffing and economics

Heart surgery first for East Lancashire (UK)

"Heart surgery specialists have made history by performing the first life-saving angioplasty operations in East Lancashire. Consultant cardiologists Dr Ravi Singh, Dr John McDonald and Dr Kanarath Balachandran carried out the procedures in the Royal Blackburn Hospital’s existing cardiac catheter laboratory. Until now patients who needed the operation had to travel to either Blackpool or Manchester. But the experts used new equip-ment, which will be housed in a new £3million laboratory by May, so the technique can be carried out routinely in the region. Peter South, 67, from Barley, was the first to undergo the procedure"

6-month-old cardiac program saves Norwalk man (USA)

"John Morton had no idea a petition he signed for Norwalk Hospital, CT, in 2005 would help establish the very service that saved his life four years later. But when Morton, a 57-year-old Norwalk, man, felt the telltale chest pangs at 3 a.m. Sunday, the staff and the equipment of Norwalk Hospital's emergency angioplasty program were waiting for him. Six months ago, Morton would have been stabilized and transferred by ambulance to St. Vincent's Medical Center in Bridgeport for the emergency procedure, in which a balloon-tipped catheter is inserted into a narrow or clogged artery, then inflated to restore blood flow. And six months ago, Morton probably wouldn't have survived the transfer, said his cardiologist, Dr. Robert Jumper. The state approved Norwalk's emergency angioplasty program in January, almost a decade after its initial request in 2000. Doctors say it is the most effective intervention in saving lives and minimizing heart damage during an acute heart attack. In July, Norwalk Hospital began performing the procedures after months of training rotating through a supervising hospital, St. Vincent's, and performing mock drills in Norwalk, said Ed Staunton, director of operations. As of Wednesday, the hospital had treated 33 patients in its state-of-the-art cardiac and vascular catheterization laboratory, Staunton said"

Kelowna General Hospital initiates cardiac angioplasty surgeries (Canada)

"For the first time in B.C. - outside of the Lower Mainland or Victoria - angioplasty procedures where a microscopic balloon is introduced into an artery, inflated, and a stent put in to keep the artery open have been performed at Kelowna General Hospital. Last week, the first 10 angioplasties were completed here, a milestone that brought Health Minister Kevin Falcon to town Friday to make the announcement. He said the phased-in cardiac program at KGH, which will feature heart surgery starting in 2012, is on budget and four months ahead of schedule" - Kelowna Capital News

Sam Allardyce to undergo surgery (UK)

Blackburn Rovers manager Sam Allardyce will miss his side's next three matches in order to undergo an operation on a coronary artery, the club has revealed. Allardyce, who turned 55 last month, "complained of brief episodes of chest discomfort" according to the club. His treatment involves an angioplasty - an operation to widen the artery using an artificial tube called a stent. "Sam is very disappointed, but his well-being is of prime consideration," said Rovers chairman John Williams. "We all appreciate that Premier League football is a stressful business and prevention is always better than cure." - BBC

Women have 'same heart symptoms' (Canada)

"It is a myth that women have different heart attack symptoms from men, according to Canadian researchers. A study presented at the Canadian Cardiovascular Congress found no gender differences in symptoms after studying 305 patients undergoing angioplasty. They say it is a commonly held belief that men and women feel the effects of a heart attack differently. Dr Beth Abramson, of Canada's Heart and Stroke Foundation, said: "Heart disease is an equal-opportunities killer." - BBC

Surgery better than angioplasty for narrowed neck artery

The latest results from the longest-running study yet confirm that surgery is better than artery-opening angioplasty in preventing strokes caused by blockage of the carotid artery, the largest vessel carrying blood to the brain. "In contrast with endovascular treatment [angioplasty], surgical patients had about half the rate of strokes in long-term follow-up," said Dr. Martin M. Brown, a professor of stroke medicine at University College London Institute of Neurology, and a senior author of two reports in the October issue of the Lancet Neurology - HealthDay

Stenting a good option for left main heart artery

"Twelve-year data on treatment of blockage of the left main heart artery indicate that using a drug-coated stent is an effective alternative to bypass surgery, doctors report. The study of 314 people who underwent the procedure between 1997 and 2008 in Poland supports the findings of a large European trial, which found no difference in the death rate between bypass surgery and angioplasty for the condition, according to a report published online August 19 and in an upcoming print issue of the Journal of the American College of Cardiology by a group of physicians from Poland and the United States"

Is angioplasty worth the risk?

"Angioplasty is one of the most common medical procedures in the U.S.; in 2006 more than 1.3 million were done. But recent studies have cast doubt on its benefits. Now CBS News medical correspondent Dr. Jon LaPook reports on the controversy over whether too many people are getting angioplasty at hospitals that may not be prepared if something goes wrong"

Board delays vote on cardiac care bid (USA)

"Helen Keller Hospital in Sheffield, Alabama, must wait until at least July to learn if its proposal to do procedures that will open clogged arteries will move forward in the required state approval process. The Statewide Health Coordinating Council delayed a vote on a request by Keller and three other hospitals that want to do percutaneous coronary interventions without on-site open heart surgery availability. Crestwood Hospital in Huntsville, Decatur General Hospital and Stringfellow Memorial Hospital in Anniston joined Keller in the request for a change in the state health plan to allow the procedures. The hospitals contend that the health plan does not recognize modern advances that make inserting stents, balloons and other catheterizations to open arteries much safer than when the state wrote the guidelines"

Study calls for 'as soon as possible' treatment standard for heart attack patients

"Once in hospital, heart attack patients should be treated without delay to cut their risk of death, ideally within even less than the 90 minutes currently recommended by clinical guidelines, say researchers in a paper published on bmj.com today. After a heart attack, patients often undergo a procedure using a balloon-tipped catheter that is inserted into a main artery, pushed into the narrowed coronary artery, and inflated to clear the blockage. This is called primary percutaneous coronary intervention, or more simply balloon angioplasty. The time between a patient's arrival at hospital and first balloon inflation is known as the 'door-to-balloon time.' The current target is 90 minutes, but the benefits of reducing this time even further is still unclear. So researchers based in the United States set out to investigate the association between door-to-balloon time and deaths in hospital among patients undergoing balloon angioplasty after a heart attack." - Science Centric

Why females do not fare as well as men in undergoing angioplasty for heart attacks

"Age, condition and treatment delay are among the reasons women who undergo angioplasty for heart attack often do not fare as well as do men, according to two studies presented at the Society for Cardiovascular Angiography and Interventions (SCAI) 32nd Annual Scientific Sessions. These studies, which are among the first to document outcomes in female patients treated with angioplasty and stenting for a heart attack, may help close the outcome gap between women and men." - ScienceDaily

Study finds African Americans at greater risk after PCI (USA)

"A study from one of the largest public health systems in the country (USA) has found that African American patients experienced significantly worse outcomes after angioplasty and stenting than patients of other races, though researchers are not sure why. According to data reported at the Society for Cardiovascular Angiography and Interventions (SCAI) 32nd Annual Scientific Sessions, no single factor explains why African Americans were at higher risk after percutaneous coronary intervention (PCI), but the hazard was clear" - Physorg.com

Irregular heartbeat during angioplasty could raise death risk

People treated for heart attack who experience abnormal heart rhythms during artery-opening procedures such as angioplasty may be at increased risk of death, a new study suggests. The finding could challenge current cardiac care guidelines, experts say. The study focused on patients who had heartbeat abnormalities called ventricular tachycardia or ventricular fibrillation when they underwent what is formally called a percutaneous coronary intervention (PCI) - such as angioplasty with or without stent placement - for heart attack. Patients who experienced these cardiac arrhythmias during the procedure had about triple the odds of dying within 90 days as those whose hearts beat normally, the researchers found. "Arrhythmias have a significant impact on longer-term survival," concluded study author Dr. Rajendra H. Mehta, an associate consulting professor of medicine at Duke University in Durham, N.C. His team published the findings in the May 6 issue of the Journal of the American Medical Association - HealthDay

Heartfelt thanks for new St John of God Hospital procedures (Australia)

"New procedures at St John of God Hospital are already saving the lives of cardiac patients. In a first for regional Victoria, the hospital's catheter laboratory is now doing cardiac angioplasty and stenting, which opens artery blockages and allows blood flow to the heart. Previously, patients needing the procedure were sent to Melbourne or Geelong. Cardiologist Dr Chris Hengel said having the procedures in Ballarat meant patients no longer had to travel for treatment, where they often had to wait days. "Patients can have the stents when they need, as opposed to when Melbourne labs can fit them in," Dr Hengel said. When Ballarat man Stewart Hutchison, 67, had a heart attack on Saturday, he expected to go to Melbourne this week for treatment. But thanks to the new service, Mr Hutchison was treated in Ballarat on Monday and was going home today. Coronary angioplasty and stenting is the use of a balloon to open up a coronary blockage, followed by the insertion of a stent, which is a tiny metal scaffold used to hold the artery open. Mr Hutchison could not praise the service enough. "It's just fantastic and I'm fortunate I could have it here," he said. The laboratory has done up to 18 stents with the new service and aims to perform 200 stents per year. SJOG chief executive officer John Fogarty said the hospital now provided almost the whole range of cardiac procedures using state-of-the-art technology" - The Courier

Angioplasty from the wrist: interest growing but lack of training limits spread in U.S.

The transradial approach to catheter-based procedures, where the radial artery in the wrist is used for angioplasty and stents, is in its infancy in the United States, even though it is widely utilized in the rest of the world. In the past two years a number of large studies have been published showing a significant reduction in bleeding complications and mortality with the wrist approach, as compared to the standard access site used in the U.S. - the femoral (or groin) artery. Moreover, patients are able to sit up and walk almost immediately after the wrist procedure, increasing not only their comfort and recovery time, but the cost-effectiveness of the procedure, a major issue in today's healthcare environment. The question raised by this information is why the use of radial access in the United States is in the low single digits, when it is the default access site for many cardiologists in other countries?