Quicker heart treatment hasn't lowered deaths: study

A good hospital will get heart attack victims into an operating room and get their clogged artery open within 90 minutes. But a new study shows that shortening that time even further does not significantly lower the risk of dying in the hospital.

The analysis, which measured the so-called door-to-balloon time now widely used to assess the quality of heart attack care, found that shaving additional minutes off the 90-minute goal produced diminishing returns.

The results suggest that more attention should be devoted to getting heart attack victims to the hospital sooner for the treatment, usually with a balloon or stent, known as percutaneous coronary intervention (PCI).

"Door-to-balloon time is a core measure by which hospitals that do PCI treatment are measured. That core metric is not going to go away based on this study, nor should it," said Dr. Joseph Fredi, an interventional cardiologist at Vanderbilt University Medical Center's Heart and Vascular Institute in Nashville, Tennessee, who was not involved in the study.

"I hope people don't take away from it that we can start relaxing and not have to move heaven and earth to not achieve that metric they way hospitals do now," he told Reuters Health in a telephone interview.

In fact, patients who could not get a PCI within 90 minutes died at a rate that was roughly double that of patients who received treatment in 90 minutes or less, according to the report published in the New England Journal of Medicine.

Coauthor of the new study Dr. Hitinder Gurm of the University of Michigan and the Veterans Affairs Ann Arbor Healthcare System told Reuters Health in a telephone interview, "I don't think there is anything more we can do at the hospital level."

Reducing the time in the hospital "is an effort that has been successful, but now we have to look beyond that" and get people to the hospital faster, he said.

"We need to focus on the total ischemic time," he said, referring to the time the heart muscle is starved of oxygen. "When the patient takes three hours to get to the hospital, the 60 minutes or 90 minutes it takes for treatment doesn't make as much of a difference."

"Most of the benefit is in the first two to three hours," Gurm said. "If we can push the whole effort upstream, that's where I think we can see the reduction."

But that's only a theory, Fredi cautioned. "It may be more complicated than saying if we just restore blood flow, everything will be okay."

Based on earlier studies showing fewer deaths with faster treatment, doctors and regulators have been pushing for years to treat heart attack patients faster - particularly those with the most damaging type of heart attack, caused by a major coronary artery blockage and called ST-segment elevation for a telltale pattern it produces on a heart monitor.