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Angioplasty & Stents - Angioplasty for Mild Heart Attack

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Angioplasty & Stents
Risks
Effectiveness
Angioplasty vs. Clot Busters
Angioplasty After Clot Busters
Other Devices
Artery Re-narrowing
Angioplasty for Mild Heart Attack
Choosing a Hospital & Doctor
The Angioplasty Procedure

How does a mild heart attack differ from a typical heart attack?

During a typical heart attack, a blood clot lodges in one of the small arteries of the heart blocking blood flow to the heart. This produces an easily identifiable pattern during ECG or electrocardiogram testing (called ST-segment elevation). Some people do not have a complete blockage in the artery, instead the clot interrupts the blood flow only intermittently. This type of unstable angina or mild heart attack does not produce the typical heart attack pattern on the ECG; the pattern produced is usually called non-ST-segment elevation (or NSTEMI, pronounced en-stemee).

Is angioplasty an effective treatment for a mild heart attack

The benefits of angioplasty are well established in typical heart attack patients but it is less clear whether patients with unstable angina or mild heart attack (NSTEMI) should be treated so aggressively. For the past few years, researchers have been comparing two types of treatment—a conservative strategy using medications first and saving invasive procedures for patients who do not respond to drugs—or a more aggressive strategy where the patient is sent immediately for cardiac catheterization and then treated with angioplasty or bypass surgery.

Which is better: invasive or conservative treatment

Recent studies have shown that the aggressive strategy reduces the risk of dying or having a heart attack, especially in high-risk patients. However; the benefits are less pronounced in lower-risk patients. There are 2 major studies that had conflicting findings for women – the FRISC-II study (the acronym stands for Fast Revascularization during Instability in Coronary artery disease) and the TACTICS-TIMI-18 study (Treat angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis in Myocardial Infarction).

The FRISC-II study found that men benefited from the aggressive strategy but women were no better off.96 The women treated with catheterization followed by angioplasty or bypass surgery were more likely to suffer problems than men treated this way. In contrast, TACTICS-TIMI found that women were better off with the aggressive strategy.97 One explanation for the different results is the much longer time delay before the angioplasty or bypass was performed in the FRISC-II study—7 days compared with 2 days in TACTICS-TIMI. This may mean that the researchers left it too late to see a benefit for the aggressive approach. Another explanation is that women treated aggressively in FRISC-II were just as likely to undergo bypass surgery as angioplasty. The women who underwent bypass surgery had a very high risk of dying within one year – nearly 10% died compared with only 1.2% of the men who had bypass surgery.98 In TACTICS-TIMI, women treated invasively were more likely to be treated with angioplasty than bypass surgery and there was a much lower risk of death for women who underwent bypass surgery.

How do doctors decide which treatment to use

While the results of large trials suggest that the aggressive strategy is usually the better choice, it should probably be used selectively rather than routinely.99 Patients with unstable angina or a mild heart attack who are considered high-risk seem to particularly benefit from the aggressive approach. Blood tests are one means to identify high-risk patients. When the heart muscle is damaged, proteins (called troponins) are released into the bloodstream. Women and men with high levels of these proteins are less likely to die or have a heart attack if they are treated with the early aggressive approach involving catheterization and angioplasty than if they are treated conservatively. That said, the aggressive approach may be unnecessary for low-risk patients. One analysis of TACTICS-TIMI-18 showed little or no difference between the invasive and the conservative strategy in low-risk patients.100



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