Research: Improving treatment of patients with heart attack
An MUHC study looks at the best way to treat
patients with heart attack
When faced with
patients suffering a heart attack, doctors have two choices: inject
them with medication to dissolve the blood clot (fibrinolytic
therapy) or insert a small balloon to open the blocked artery
(primary percutaneous coronary intervention (PCI)). Guidelines for
treating heart attacks are generally based on clinical trials that
do not take "real-life" conditions into account. The latest study
by Dr. Thao Huynh of the Research Institute of the MUHC and Â鶹Çø
University analyses these gaps and provides potential solutions to
improve treatment of heart attack. Her article was published in the
June 23rd issue of Circulation.
In this study, Dr. Huynh compares the results of 23 randomized controlled trials conducted under controlled experimental conditions, with the results of 32 observational studies reporting on the treatment of patients with heart attacks in routine clinical conditions.
Both types of studies show the superiority of PCI over fibrinolytic therapy in reducing mortality and the risk of further episodes of heart attack and stroke over the short term. However, the advantage of PCI is even more apparent in randomized controlled trials where delays in providing primary PCI are shorter than in routine clinical conditions.
"This study indeed demonstrates that we have to work to reduce these delays if we are to maximize the effectiveness of PCI," explained Dr. Huynh. "When it comes to treating heart attack, reducing delays in providing treatment is the number one priority. It is also essential that patients with symptoms of heart attack seek prompt medical attention. Delays by patients to seek medical attention may further increase delays to treatment of heart attack. "
Analysis of randomized controlled trials shows that primary PCI also reduces long-term mortality and repeat heart attack. However, this long-term benefit of primary PCI is not observed in observational studies where patients receive treatment within routine clinical conditions.
"The benefit of primary PCI can be lost over the long term if patients are not receiving optimal medical therapy after discharge from hospital. These medications are essential to prevent repeat heart attack." warned Dr. Huynh.
Dr. Thao Huynh is a
cardiologist at the MUHC and a researcher in the Cardiovascular
Diseases and Critical Care Axis at the Research Institute of the
MUHC. She is also an Associate Professor in in the Division of
Cardiology at Â鶹Çø.
Funding
This study was funded by the
Agence d'évaluation des technologies et modes d'intervention du
Québec (AETMIS), Canadian Institutes of Health Research (CIHR) Team
Grant, and the Department of Medicine of Â鶹Çø Health University
Center.
Partners
This article was co-authored by
Dr. Thao Huynh, Research Institute of the MUHC; Dr. Lawrence
Joseph, Â鶹Çø; Dr. Stéphane Perron, Dr. Jennifer O'
Loughlin, and Dr. Pierre Théroux, Université de Montréal; Dr.
Michel Labrecque, Université de Laval; and Dr. Jack V. Tu,
University of Toronto.
The Research Institute of the Â鶹Çø Health
Centre (RI MUHC) is a world-renowned biomedical and
healthcare hospital research centre. Located in Montreal, Quebec,
the Institute is the research arm of the MUHC, the university
health centre affiliated with the Faculty of Medicine at Â鶹Çø
University. The Institute supports over 600 researchers, nearly
1,200 graduate and post-doctoral students; it also operates more
than 300 laboratories devoted to a broad spectrum of fundamental
and clinical research. The Research Institute operates at the
forefront of knowledge, innovation and technology and is
inextricably linked to the clinical programs of the MUHC, ensuring
that patients benefit directly from the latest research-based
knowledge. The Research Institute of the MUHC is supported in part
by the Fonds de la recherche en santé du Québec.
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Contact:
Isabelle Kling, Communications
Coordinator (research)
MUHC Public Relations and Communications - Tel.: (514)
843 1560
ian.popple [at] muhc.mcgill.ca