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!
Unique brain 'fingerprint' can predict drug effectiveness
11.07.2018 | McGill University
Direct conversion of non-neuronal cells into nerve cells
03.07.2018 | Universitätsmedizin der Johannes Gutenberg-Universität Mainz
For the first time ever, scientists have determined the cosmic origin of highest-energy neutrinos. A research group led by IceCube scientist Elisa Resconi, spokesperson of the Collaborative Research Center SFB1258 at the Technical University of Munich (TUM), provides an important piece of evidence that the particles detected by the IceCube neutrino telescope at the South Pole originate from a galaxy four billion light-years away from Earth.
To rule out other origins with certainty, the team led by neutrino physicist Elisa Resconi from the Technical University of Munich and multi-wavelength...
For the first time a team of researchers have discovered two different phases of magnetic skyrmions in a single material. Physicists of the Technical Universities of Munich and Dresden and the University of Cologne can now better study and understand the properties of these magnetic structures, which are important for both basic research and applications.
Whirlpools are an everyday experience in a bath tub: When the water is drained a circular vortex is formed. Typically, such whirls are rather stable. Similar...
Physicists working with Roland Wester at the University of Innsbruck have investigated if and how chemical reactions can be influenced by targeted vibrational excitation of the reactants. They were able to demonstrate that excitation with a laser beam does not affect the efficiency of a chemical exchange reaction and that the excited molecular group acts only as a spectator in the reaction.
A frequently used reaction in organic chemistry is nucleophilic substitution. It plays, for example, an important role in in the synthesis of new chemical...
Optical spectroscopy allows investigating the energy structure and dynamic properties of complex quantum systems. Researchers from the University of Würzburg present two new approaches of coherent two-dimensional spectroscopy.
"Put an excitation into the system and observe how it evolves." According to physicist Professor Tobias Brixner, this is the credo of optical spectroscopy....
Ultra-short, high-intensity X-ray flashes open the door to the foundations of chemical reactions. Free-electron lasers generate these kinds of pulses, but there is a catch: the pulses vary in duration and energy. An international research team has now presented a solution: Using a ring of 16 detectors and a circularly polarized laser beam, they can determine both factors with attosecond accuracy.
Free-electron lasers (FELs) generate extremely short and intense X-ray flashes. Researchers can use these flashes to resolve structures with diameters on the...
13.07.2018 | Event News
12.07.2018 | Event News
03.07.2018 | Event News
13.07.2018 | Event News
13.07.2018 | Materials Sciences
13.07.2018 | Life Sciences