Drug therapy doesn't buy time in heart attack

By Gene Emery

BOSTON (Reuters) - Drugs given to buy time for heart attack patients who do not have quick access to angioplasty do not help them live any longer or prevent further heart problems, researchers reported on Wednesday.

The international study of thousands of patients is bad news for people who do not live near a hospital equipped to reopen blocked arteries or who come to a hospital where there is no staff available to do the procedure, the researchers report in the New England Journal of Medicine.

In those cases, doctors try to chemically clear the blockage by giving blood thinning and clot-busting drugs so patients can be delivered to an operating room, where surgeons can thread a balloon into the narrowed artery and force it open. Doctors try to have the artery open 90 minutes after a patient comes through an emergency room door.

The drugs used in this study, Lilly's ReoPro, or abciximab, and PDL BioPharma's Retavase, or reteplase, seemed to help clear things out, based on improvements in the electrocardiograms.

But the risk of death, congestive heart failure, irregular rhythm or cardiogenic shock was about 10 percent for all 2,452 volunteers, no matter what whether they received ReoPro just before balloon treatment or either ReoPro alone or a RepPro-Retavase combination hours before going into the operating room for the procedure, also known as a percutaneous coronary intervention, or PCI.

The researchers, led by Dr. Stephen Ellis of the Cleveland Clinic in Ohio, said the findings show that doctors will need to work harder to shorten the time between the patient's arrival in an emergency room and the moment a balloon is opening up the blocked artery.

"The limitations of these facilitated approaches should provide further impetus both to develop triage systems that can shorten the door-to-balloon time for high-quality primary PCI when impediments to rapid PCI exist and to evaluate other treatment strategies," they said.

For 60 percent of the U.S. population, the hospital closest to home does not have the capability to do angioplasty.

In a commentary in the Journal, Dr. Jane Leopold of Harvard Medical School in Boston said other studies have suggested that giving the drugs to buy time, known as "facilitated PCI," offers little benefit.

"In fact, the totality of the data suggests that facilitated PCI is not beneficial and may be detrimental," she said.

The new study suggests that the two drugs may increase the risk of dangerous bleeding.

(Editing by Maggie Fox and Eric Beech)