After a heart attack, treatment with angioplasty or bypass surgery during the initial hospital stay appears to improve survival compared with a more delayed, conservative approach, new research shows.
As reported in Circulation: Journal of the American Heart Association, Dr. Padma Kaul, from the University of Alberta in Edmonton, Canada, and colleagues analyzed data for heart attack patients in Canada and the US enrolled in a trial between 1990 and 1993. More than 25,000 patients were included in the analysis. The authors found that US patients were about three times more likely to undergo angioplasty or bypass surgery during their initial hospital stay than were Canadian patients. In an earlier study, the Canadian patients were found to have a lower survival rate at 1 year than their US peers, but the difference was small and was not considered sufficient to justify changes in Canadian health policy. In the new study, however, the researchers were able to extend the observation period out to 5 years. When they did this, the survival difference was more pronounced — Canadian patients were 17 percent less likely to be alive at 5 years than were US patients. Further analysis revealed that Canadian patients who were treated early fared just as well as US patients. Currently, the rate of angioplasty or bypass surgery in Canada more closely resembles that in the US, Kaul told Reuters Health. “What impact that has on long-term (risk of death), and whether the differences between the two countries has dissipated as a result of this change in practice, we do not know yet,” she added. Regardless, “this study has implications not only for US and Canada, but also practices in Europe,” she said. “The UK has very low (angioplasty/bypass surgery) rates, as do many other European countries,” where long-term outcomes may suffer as a result. (SOURCE: Circulation: Reuters Health News: Karla Gale: September 2004.)