News | Cath Lab | December 29, 2015

Treatment Time Lags for Heart Attack Patients with Prior Bypass Graft Surgery

Patients with prior angioplasty, no previous interventions are healthier and treated faster

December 29, 2015 — Heart attack patients who had previously undergone coronary artery bypass graft surgery were less likely than other heart attack patients, including those with prior angioplasty, to be treated within the 90-minute recommended “door-to-balloon time,” according to a study published today in the JACC: Cardiovascular Interventions. Door-to-balloon time refers to the time from a patient’s arrival at the hospital to treatment to restore blood flow to the heart with angioplasty and a stent.   

Using data from the National Cardiovascular Data Registry CathPCI Registry linked with the ACTION Registry-GWTG, researchers examined records of 15,628 heart attack patients treated at 297 U.S. hospitals between June 2009 and September 2011. Of that group, 6 percent had a history of previous coronary artery bypass graft surgery, 19 percent had previous angioplasty, and 75 percent had no prior history of procedures.
Heart attack patients with prior revascularization through surgery were older, with an average age of 66, than those with prior angioplasty, average age 60, or without any previous interventions, average age 59; and they were more likely to have other medical conditions, including high blood pressure, high cholesterol, and diabetes.

Results showed that 76 percent of patients with prior revascularization via open-heart surgery were treated within the recommended 90-minute door-to-balloon time compared to 88.5 percent of patients with prior angioplasty and 88 percent of patients with no previous interventions. Door-to-balloon time was achieved in 90 percent of patients with a prior history of angioplasty with a stent when the new lesion was located in the previous stent and in 87.3 percent of patients if the lesion was in a non-stented area. For patients with a prior history of bypass graft surgery, 75.9 percent had their angioplasty done within 90 minutes when the new lesion was in the graft site, as did 77 percent when the lesion was located in a new vessel.

Overall, 88.3 percent of patients in the prior surgery group had successful procedures compared with 93.4 percent of patients who had a prior angioplasty and 94.4 percent of patients with no prior interventions. After adjusting for clinical and procedural differences, the study found no significant differences in in-hospital mortality, major adverse events, and major bleeding among the three groups.     

Luis Gruberg, M.D., FACC, the study’s lead author and professor of medicine at Stony Brook University in New York said patients with a history of prior coronary artery bypass surgery have more complex anatomy and more co-morbidities, and therefore have a more prolonged door-to-balloon time compared to the other groups in the study. “Nonetheless, every effort should be made to improve timeliness in patients with a history of previous coronary artery bypass surgery,” Gruberg said.

In an accompanying editorial, John S. Douglas Jr., M.D., professor of medicine at the Emory University School of Medicine in Atlanta, said the delay in door-to-balloon time for prior bypass graft patients has important implications for salvaging the heart muscle. According to Douglas, because door-to-catheterization lab and catheterization lab-to-balloon times were not provided, it’s not clear where the delay occurred. “Increased awareness of ‘time is muscle,’” Douglas said, “may lead to shortened door-to-cath lab times and timely performance” for the more difficult patients.     

Douglas said the study “should be interpreted as a ‘call to action’ with the goal of earliest possible treatment in all heart attack patients, including those who have had prior coronary artery bypass graft surgery.”  

For more information: www.acc.org

Related Content

Biotronik Studies Demonstrate Efficacy of Minimizing Metal Burden in SFA Therapy
News | Stents Bare Metal| September 22, 2017
Physicians demonstrated that reducing metal burden in superficial femoral artery (SFA) therapy could effectively reduce...
Edwards Inspiris Resilia Valve Receives FDA Approval
News | Heart Valve Technology| September 21, 2017
Edwards Lifesciences Corp. recently received U.S. Food and Drug Administration (FDA) approval for its Inspiris Resilia...
MyoKardia Presents Additional Positive Data From Phase 2 PIONEER-HCM Study at HFSA 2017
News | Heart Failure| September 21, 2017
MyoKardia Inc. announced that additional positive data from the first patient cohort of its Phase 2 PIONEER-HCM study...
Tryton Side Branch Stent Recognized With Premier Technology Breakthrough Award
News | Stents Bifurcation| September 21, 2017
September 21, 2017 — Cardinal Health and Tryton Medical Inc.
DISRUPT BTK Study Shows Positive Results With Lithoplasty in Calcified Lesions Below the Knee
News | Peripheral Artery Disease (PAD)| September 20, 2017
Shockwave Medical reported positive results from the DISRUPT BTK Study, which were presented at the annual...
Corindus Announces First Patient Enrolled in PRECISION GRX Registry
News | Robotic Systems| September 18, 2017
September 18, 2017 — Corindus Vascular Robotics Inc.
Two-Year ILLUMENATE Trial Data Demonstrate Efficacy of Stellarex Drug-Coated Balloon
News | Drug-Eluting Balloons| September 18, 2017
Philips announced the two-year results from the ILLUMENATE European randomized clinical trial (EU RCT) demonstrating...
Sentinel Cerebral Protection System Significantly Reduces Stroke and Mortality in TAVR
News | Embolic Protection Devices| September 18, 2017
September 18, 2017 – Claret Medical announced publication of a new study in the...
Fysicon Receives FDA Approval for QMAPP Hemodynamic Monitoring System
Technology | Hemodynamic Monitoring Systems| September 18, 2017
Fysicon announced that it has been granted 510(k) clearance by the U.S. Food and Drug Administration (FDA) for its...
Marijuana Associated With Three-Fold Risk of Death From Hypertension
News | Hypertension| September 14, 2017
Marijuana use is associated with a three-fold risk of death from hypertension, according to research published recently...
Overlay Init