Heart attack survival similar among those receiving clot-busting drugs, angioplasty
American Heart Association Late-Breaking Clinical Trial Report LBCT 4/Abstract: 19533 (Ballrooms C1 & C2)
- One-year survival rates after severe heart attack are similar among patients who initially receive clot-busting medications and those who undergo angioplasty.
- One year after treatment for severe heart attack, about 98 percent of patients survived in both treatment groups.
DALLAS, Nov. 18, 2013 — The one-year survival rate after a severe heart attack was similar among people who initially received clot-busting medications and those who immediately underwent angioplasty, according to a late-breaking clinical trial presented at the American Heart Association’s Scientific Sessions 2013.
The Strategic Reperfusion Early After Myocardial Infarction (STREAM) Trial included 1,892 people who suffered an ST-elevation myocardial infarction (STEMI), a heart attack in which a blood vessel is totally blocked, but weren’t able to undergo angioplasty with the first hour of arriving at the hospital. Researchers randomly assigned half of these patients to receive three medications, including age-adjusted bolus tenecteplase, clopidogrel and enoxaparin. If their symptoms persisted, they also underwent angioplasty, a procedure that opens blocked blood vessels. The other half received angioplasty, and standard drugs to prevent blood clots.
Both groups were treated within three hours of the onset of heart-attack symptoms.
Among those who first received the combined medications, 2.1 percent died, including from heart disease and stroke, compared to 1.5 percent of those who initially underwent angioplasty. This was not a significant difference.
In an earlier part of the study, patients who received clot-busting medications were slightly more likely to survive without complications 30 days after treatment. These latest findings represent the original study’s one-year follow-up.
“In this study, the combined drug strategy proved a reasonable approach to take as an initial treatment immediately after severe heart attack when angioplasty is not immediately available,” said Peter Sinnaeve, M.D., Ph.D., the study’s lead author and assistant professor of cardiology at the University of Leuven in Belgium.
The American Heart Association currently recommends clot-busting medication within the first 30 minutes and angioplasty within the first 90 minutes of hospital arrival and continues to review and adapt guidelines as appropriate. The association has developed the Mission Lifeline® program to help improve timely access to appropriate care.
Co-authors are Paul W. Armstrong, M.D.; Anthony H. Gershlick, M.D.; Patrick Goldstein, M.D.; Robert Wilcox, M.D.; Thierry Danays, M.D.; Yves Lambert, M.D.; Vitaly Sulimov, M.D., Ph.D.; Fernando Rosell Ortiz, M.D., Ph.D.; Miodrag Ostojic, M.D., Ph.D.; Robert C. Welsh, M.D.; Antonio C. Carvalho, M.D., Ph.D.; John Nanas, M.D., Ph.D.; Hans-Richard Arntz, M.D., Ph.D.; Sigrun Halvorsen, M.D., Ph.D.; Kurt Huber, M.D.; Stefan Grajek, M.D., Ph.D.; Claudio Fresco, M.D.; Erich Bluhmki, M.D., Ph.D.; Anne Regelin, Ph.D.; Louis Soulat, M.D.; Katleen Vandenberghe, Ph.D.; Kris Bogaerts, Ph.D.; and Frans Van de Werf, M.D., Ph.D. for the STREAM Investigative Team. Disclosures
Boehringer Ingelheim Pharmaceuticals funded the study.
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Note: Actual presentation is 3:45 p.m. CT/4:45 p.m. ET, Monday, Nov. 18, 2013, in Ballrooms C1 & C2.
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