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.
Richard Lane | alfa
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