Clot-busting drugs help achieve better outcomes in heart attack patients, study finds
Serious heart attack patients in northern Alberta are offered a treatment protocol that's not the standard in the rest of the province and new research shows it helps those patients achieve better health outcomes.
Dr. Kevin Bainey, director of the Cardiac Catheterization Lab at the Mazankowski Heart Institute, analyzed data from almost 6,000 heart attack patients admitted to Edmonton-area hospitals from northern Alberta.
In all of the cases, the patient's coronary artery was completely blocked. The prevailing treatment for such a condition is to rush a patient to a hospital that can perform an angioplasty, where a balloon catheter is inserted into the blocked vessel to expand it.
But in northern Alberta, cardiologists often advocate for an approach that sees a patient given clot-busting drugs either in their home community or in the ambulance while en route to a major hospital. The patient still receives an angioplasty, but not under emergency conditions.
The study found that, one year out, patients who were given clot-busting drugs and the balloon catheter procedure had improved survival rates and a reduction in heart failure, Bainey said.
"Our data now provides further and robust support to consider this strategy among not only patients in Alberta but across the country," said Bainey, whose work was published in the journal Circulation: Cardiovascular Interventions.
Bainey noted that Edmonton is one of few regions in the country that advocates for the pharmacological approach and he believes it's one of the reasons Edmonton has the lowest mortality rate for heart attacks in Canada.
In northern Alberta, paramedics working in more rural areas can correspond with cardiac experts at the Mazankowski Heart Institute to evaluate whether a patient is a good candidate for the clot-busting drugs, including their risk for bleeding.
Paramedics can send an ECG to Edmonton electronically. From there, the heart doctors can make a recommendation on whether to use the drugs or not. Ambulances keep the necessary drugs in stock.
"They're getting this clot-busting agent early," said Bainey. "And that drug starts to work to open up that blockage, as opposed to taking the time to get these patients transferred for a (balloon catheter) procedure.
"So because of administering this drug beforehand, it improves the chances of that artery opening up and saving heart muscle."
Bainey noted that, in Europe, recent treatment guidelines endorse the pharmaco-invasive approach. So he's hopeful it's starting to catch on.
The treatment protocol is in place in Alberta for the region from Red Deer to the north of the province. Bainey said he's advocating for it to be implemented across the province.
"When we do, it will be a big milestone"
