A Better Way to Treat Coronaries.

• Position: Brief Article

Researchers at Duke University Medical Center, Durham, N.C., say a new heart attack treatment may hold promise: Give coronary patients a quick cocktail of drugs that dissolves clots and stops them from reforming, then, an hour later, perform angioplasty to clear plaque from heart arteries that are now open. This strategy--facilitated angioplasty--appears to offer a better outcome than thrombolytic treatment (clot-busting drugs) or angioplasty alone, or even medical therapy followed by angioplasty within several days, according to cardiologist E. Magnus Ohman.

Patients having a heart attack were treated within 60 to 90 minutes after arriving at one of the 61 participating hospitals in 14 countries. They were first given two doses of reteplase, a drug that breaks up blood clots, and a loading dose and infusion of abciximab, which prevents platelets from clumping to form new clots. Both drugs are approved for use in the U.S., although their combination is still in the early stages of testing.

The drug cocktail was followed an hour later by angioplasty, a procedure that presses plaque obstructions against the artery wall by inflating a small balloon from a catheter. Then, in most patients, a small girder-like stent was implanted into the artery wall to keep the artery open. The researchers found that, 30 days after the heart attack, 16% of patients who did not have facilitated angioplasty either had died, suffered another heart attack, or needed an urgent procedure to reopen the artery, compared with 5.6% who had facilitated angioplasty.

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