A blocked artery causes a deadly kind of heart attack known as STEMI, and a rapid response to clear the blockage saves lives.
But in more than half of cases studied recently by Duke Medicine researchers, one or both of the patient's other arteries were also obstructed, raising questions about whether and when additional procedures might be undertaken.
In a study published in the Nov. 19, 2014, issue of the Journal of the American Medical Association, Duke researchers and their colleagues report the first large analysis of how often these secondary blockages occur, along with evidence that they lead to worse outcomes.
The findings provide fodder for additional studies to determine whether opening all the blocked arteries -- either at the same time, or within a few days or weeks - should become a standard procedure.
"We assumed this was a common problem, but it has not been well understood or quantified," said senior author Manesh Patel, M.D., director of Interventional Cardiology and Cardiac Catheterization Labs at Duke University Health System. "We found that more than half of the 28,000 patient scans we analyzed showed at least one additional blocked artery, and about 19 percent had blockages in all three arteries."
In their retrospective study, Patel and colleagues analyzed eight large, international clinical trials of patients who suffered an ST segment elevation myocardial infarction, or STEMI heart attack. These serious heart attacks strike nearly 250,000 people in the United State a year, according to the American Heart Association.
The researchers analyzed angiograms for the patients to quantify how many had additional blockages in one of the other three arteries of the heart. While it has long been assumed that many patients would have additional blockages, the research team's finding that 52.8 percent of patients had more than one blockage indicates the prevalence.
Further, the research team found that additional clogged arteries were associated with a small but significant increase in death rates. Patients with more than one blocked artery had a 3.3 percent mortality rate within 30 days of the heart attack, compared to a 1.9 percent death rate among those who had a single blockage.
"The current thinking among cardiologist is that it is dangerous to treat these other blockages at the same time as treating the artery that created the heart attack," Patel said. "There has been a sense that the patient is healing and it may damage the heart. But we haven't had a good idea of the risks or the potential benefits.
"Our study has established that these additional blockages appear to be very common, and these patients seem to do worse, so we need additional studies to confirm these findings and then determine when and how best to open up the additional arteries to restore blood flow," Patel said.
In addition to Patel, study authors include Duk-Woo Park; Robert M. Clare; Phillip J. Schulte; Karen S. Pieper; Linda K. Shaw; Robert M. Califf; E. Magnus Ohman; Frans Van de Werf; Sameer Hirji; Robert A. Harrington; Paul W. Armstrong; Christopher B. Granger; and Myung-Ho Jeong.
The John Bush Simson Fund provided support for the study.
Sarah Avery | EurekAlert!
Correct connections are crucial
26.06.2017 | Charité - Universitätsmedizin Berlin
One gene closer to regenerative therapy for muscular disorders
01.06.2017 | Cincinnati Children's Hospital Medical Center
An international team of scientists has proposed a new multi-disciplinary approach in which an array of new technologies will allow us to map biodiversity and the risks that wildlife is facing at the scale of whole landscapes. The findings are published in Nature Ecology and Evolution. This international research is led by the Kunming Institute of Zoology from China, University of East Anglia, University of Leicester and the Leibniz Institute for Zoo and Wildlife Research.
Using a combination of satellite and ground data, the team proposes that it is now possible to map biodiversity with an accuracy that has not been previously...
Heatwaves in the Arctic, longer periods of vegetation in Europe, severe floods in West Africa – starting in 2021, scientists want to explore the emissions of the greenhouse gas methane with the German-French satellite MERLIN. This is made possible by a new robust laser system of the Fraunhofer Institute for Laser Technology ILT in Aachen, which achieves unprecedented measurement accuracy.
Methane is primarily the result of the decomposition of organic matter. The gas has a 25 times greater warming potential than carbon dioxide, but is not as...
Hydrogen is regarded as the energy source of the future: It is produced with solar power and can be used to generate heat and electricity in fuel cells. Empa researchers have now succeeded in decoding the movement of hydrogen ions in crystals – a key step towards more efficient energy conversion in the hydrogen industry of tomorrow.
As charge carriers, electrons and ions play the leading role in electrochemical energy storage devices and converters such as batteries and fuel cells. Proton...
Scientists from the Excellence Cluster Universe at the Ludwig-Maximilians-Universität Munich have establised "Cosmowebportal", a unique data centre for cosmological simulations located at the Leibniz Supercomputing Centre (LRZ) of the Bavarian Academy of Sciences. The complete results of a series of large hydrodynamical cosmological simulations are available, with data volumes typically exceeding several hundred terabytes. Scientists worldwide can interactively explore these complex simulations via a web interface and directly access the results.
With current telescopes, scientists can observe our Universe’s galaxies and galaxy clusters and their distribution along an invisible cosmic web. From the...
Temperature measurements possible even on the smallest scale / Molecular ruby for use in material sciences, biology, and medicine
Chemists at Johannes Gutenberg University Mainz (JGU) in cooperation with researchers of the German Federal Institute for Materials Research and Testing (BAM)...
19.06.2017 | Event News
13.06.2017 | Event News
13.06.2017 | Event News
26.06.2017 | Life Sciences
26.06.2017 | Physics and Astronomy
26.06.2017 | Information Technology