Reperfusion therapy can cut risk of dying from heart attack by half
10 September 2009
From the ESC Congress 2009 in Barcelona. The wider use of reperfusion
therapy in patients with heart attack (acute myocardial infarction —
AMI) can save millions of lives in Europe. Effective reperfusion therapy
in an AMI patient can cut the individual risk of dying by half.
AMI is caused by a sudden blockage of a coronary artery, one of the
vessels supplying the heart muscle with oxygen and nutrients. Effective
reperfusion therapy provides a timely and sustainable reopening of the
The WHO MONICA* project showed that in European centres in the
mid-1990s, in-hospital mortality of AMI patients was 13%; this was a
time when only about 40% of the patients had reperfusion therapy. Today,
specialist centres can provide effective reperfusion therapy to more
than 90% of their AMI patients. In such centres, in-hospital mortality
rate is now as low as around 5%.
The first development in reperfusion therapy was the application of
fibrinolytic agents to dissolve the blood clots causing the vessel
blockage. Analysis of data from earlier studies reveals that, on
average, fibrinolytic agents can reduce infarct-related mortality rate
by 18% compared with no reperfusion therapy. Fibrinolytic therapy is
universally available and is still the mainstay of reperfusion therapy
where healthcare resources are limited.
More modern catheter-based reperfusion strategies, however, are more
effective. Compared with what can be achieved by clot-buster drugs,
catheter-based therapy reduces infarct-related mortality by a further
37%. Using this approach, the coronary artery is re-opened mechanically
with a balloon catheter and vessel patency is usually stabilised by
placement of a stent.
Potent adjunct antithrombotic drug therapy prevents recurrent clot
formation. The larger survival benefit from catheter-based reperfusion
therapy as compared with fibrinolytic therapy can be attributed to a
higher success rate in reopening blocked vessels (90% versus 40-60%) and
to better sustainability.
If no reperfusion therapy is initiated and the infarct-related
coronary artery continues to be blocked, the heart muscle supplied by
this vessel is destined to die. Loss of functional heart muscle can
cause death by pump failure or break-down of normal heart rhythm.
Moreover, it is a major cause of long-term illness due to heart failure.
Effective reperfusion therapy can prevent the death of heart muscle
cells and salvages a large proportion of the heart muscle at risk. In
this way, reperfusion therapy effectively prevents chronic illness. The
percentage of heart-muscle salvage varies to a large extent on
reperfusion modality, timing of reperfusion and patient characteristics.
Catheter-based reperfusion usually salvages around 60% of the heart
muscle at risk. For the individual patient this often means a normal
life, despite having suffered a heart attack.
* World Health Organisation Multinational Monitoring of Trends and
Determinants in Cardiovascular Disease population.
Bookmark this page