Conservative vs. Aggressive Treatment.

• Position: Use of thrombolytic drugs for heart attacks - Brief Article - Statistical Data Included

One out of three patients worldwide who suffer a second heart attack shortly after being hospitalized for a first one are not receiving the best care available, according to Duke University Medical Center, Durham, N.C., researchers. They say that many of these patients continue to be treated conservatively in spite of newer and more aggressive therapies shown to improve mortality rates almost three-fold.

About four percent of those patients hospitalized with a heart attack and treated with thrombolytic agents, or clot-busters, will suffer a second heart attack event, or re-infarction, during the initial hospital stay. Of those, approximately 17% will die within 30 days. "This is a group of patients that has not been well studied," maintains Michael Hudson, cardiology fellow at the Duke Clinical Research Institute. "The results of our analysis show that, instead of taking a conservative approach, physicians should be treating these patients more aggressively."

For the study, readministration of the thrombolytic agent, or an emergency revascularization procedure, such as angioplasty or coronary artery bypass surgery, were considered the aggressive therapies. The conservative approach entailed not employing either of those strategies. "In our analysis, the patients treated with either aggressive treatment strategy had a mortality rate after 30 days of about 10%, compared to 28% for those treated conservatively," Hudson explains.

The Duke team analyzed data from two large international, multicenter thrombolytic trials conducted six years apart: GUSTO-I, conducted from 1990 to 1993, involved 41,021 patients, and ASSENT II, conducted from 1997 to 1998, involved 16,950 patients. Both studied the effectiveness of different clot-busters in reducing mortality following myocardial infarction, or heart attack...