Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:


Coronary angioplasty soon after medical therapy could be best treatment for heart-attack patients


Results of a randomised trial in this week’s issue of THE LANCET suggest that a more aggressive approach involving coronary angioplasty soon after anti-clotting medical therapy is safe and could offer a better prognosis than more conservative treatment for patients who have had heart attack.

Medical therapy to reduce blood clotting (fibrinolysis) is widely used to treat people after heart attack. Coronary angioplasty is also effective for patients with heart attack, although the time taken to transfer patients to cardiac centres limits its use. Current guidelines do not recommend angioplasty soon after medical therapy because of concerns about increased risk of bleeding and other cardiovascular problems.

Investigators in the GRACIA-1 trial assessed whether, in an era of more sophisticated angioplasty materials and newer anti-clotting agents, coronary angioplasty within 24 hours of medical therapy could improve the outcome for heart-attack patients compared with those treated conservatively (medical therapy and subsequent angioplasty if indicated by ischaemia). 500 patients from Spain and Portugal who had a heart attack accompanied by a change in ECG profile known as STEMI (ST segment elevation myocardial infharction) were randomly assigned to either type of treatment.

The primary endpoint of the study—the combined rate of death, reinfarction, or revascularisation at 12 months—was more than halved among patients given angioplasty soon after medical therapy compared with those treated conservatively (9% compared with 21%). At 30 days both groups had a similar incidence of cardiac events. In-hospital incidence of revascularisation induced by spontaneous recurrence of ischaemia was higher in patients in the conservative group than in those in the invasive group.

Investigator Francisco Fernandez-Avilés (Hospital Universitario de Valladolid, Spain) comments: “Some practical conclusions can be drawn from the GRACIA-1 trial. First, the results reinforce recent evidence about the benefit of early intervention over a conservative approach for patients with acute coronary syndromes in the era of modern antiplatelets and stenting. According to our results, the benefit of early intervention not only applies to patients with acute coronary syndromes without ST-segment elevation but also to patients with STEMI treated with thrombolytics. The importance of this finding for clinical practice relates to the fact that, unlike primary angioplasty, the strategy of stenting hours after intravenous thrombolysis is applicable to the entire population with acute myocardial infarction, and represents a good alternative for the still high proportion of patients with STEMI for whom primary angioplasty is not available.”

In an accompanying commentary (p 1014), Freek Verheugt (University Medical Center St Radboud, Nijmegen, Netherlands) concludes: “The major advantages of an elective intervention (mean 17 hours after lysis) in GRACIA are the day-time logistics for transport and catheterisation, and the absence of bleeding induced by lytic-therapy angioplasty. The grace of this strategy is, of course, not only attractive to patients but also for the catheterisation and ambulance teams…However, both GRACIA and ALKK [a similar trial from Germany} are too small to be conclusive about long-term mortality, the only hard endpoint in trials with an open design.”

Richard Lane | alfa
Further information:

More articles from Health and Medicine:

nachricht Advanced analysis of brain structure shape may track progression to Alzheimer's disease
26.10.2016 | Massachusetts General Hospital

nachricht Indian roadside refuse fires produce toxic rainbow
26.10.2016 | Duke University

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Etching Microstructures with Lasers

Ultrafast lasers have introduced new possibilities in engraving ultrafine structures, and scientists are now also investigating how to use them to etch microstructures into thin glass. There are possible applications in analytics (lab on a chip) and especially in electronics and the consumer sector, where great interest has been shown.

This new method was born of a surprising phenomenon: irradiating glass in a particular way with an ultrafast laser has the effect of making the glass up to a...

Im Focus: Light-driven atomic rotations excite magnetic waves

Terahertz excitation of selected crystal vibrations leads to an effective magnetic field that drives coherent spin motion

Controlling functional properties by light is one of the grand goals in modern condensed matter physics and materials science. A new study now demonstrates how...

Im Focus: New 3-D wiring technique brings scalable quantum computers closer to reality

Researchers from the Institute for Quantum Computing (IQC) at the University of Waterloo led the development of a new extensible wiring technique capable of controlling superconducting quantum bits, representing a significant step towards to the realization of a scalable quantum computer.

"The quantum socket is a wiring method that uses three-dimensional wires based on spring-loaded pins to address individual qubits," said Jeremy Béjanin, a PhD...

Im Focus: Scientists develop a semiconductor nanocomposite material that moves in response to light

In a paper in Scientific Reports, a research team at Worcester Polytechnic Institute describes a novel light-activated phenomenon that could become the basis for applications as diverse as microscopic robotic grippers and more efficient solar cells.

A research team at Worcester Polytechnic Institute (WPI) has developed a revolutionary, light-activated semiconductor nanocomposite material that can be used...

Im Focus: Diamonds aren't forever: Sandia, Harvard team create first quantum computer bridge

By forcefully embedding two silicon atoms in a diamond matrix, Sandia researchers have demonstrated for the first time on a single chip all the components needed to create a quantum bridge to link quantum computers together.

"People have already built small quantum computers," says Sandia researcher Ryan Camacho. "Maybe the first useful one won't be a single giant quantum computer...

All Focus news of the innovation-report >>>



Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

Agricultural Trade Developments and Potentials in Central Asia and the South Caucasus

14.10.2016 | Event News

World Health Summit – Day Three: A Call to Action

12.10.2016 | Event News

Latest News

Greater Range and Longer Lifetime

26.10.2016 | Power and Electrical Engineering

VDI presents International Bionic Award of the Schauenburg Foundation

26.10.2016 | Awards Funding

3-D-printed magnets

26.10.2016 | Power and Electrical Engineering

More VideoLinks >>>