A heart-y affirmation: Current ICU interventions pump up heart attack survival

A new Swedish study confirms the efficacy of current medical interventions for the emergency treatment of symptoms and signs of acute coronary occlusion (i.e. heart attack). Published in yesterday’s Journal of the American Medical Association (JAMA), the observational study assessed the baseline characteristics, treatments and outcomes of every documented first-time case of acute coronary occlusion — in over 63,000 patients — in Sweden between 1996 and 2007. The results showed a strong association between the increased use of evidence-based therapies for acute interventions to clear coronary artery blockages, such as bypass surgery and angioplasty, and improved survival rates. Other modalities found effective in reducing mortality from heart attacks in the first 30 days include: statin drug treatment; ACE-inhibitors; and anti-platelet drugs, including Plavix and aspirin.

Over the 12-year study period, the researchers observed a 50 percent reduction in 30-day mortality and saw a drop in one-year mortality from 21 percent in 1996 to 13.3 percent in 2007. However, the study also showed significant variability in the rate at which hospitals have chosen to adopt these therapies.

"This study suggests that if you treat as the guidelines recommend, your patients will do better,” said Texas Tech University Health Sciences Center’s Dr. Debabrata Mukherjee in an accompanying editorial. “That is reassuring. It is encouraging to see that efficacy in clinical trials does seem to result in efficacy in practice."

ACSH’s Dr. Gilbert Ross informs us that, "iIn the 1990s, for example, we didn’t know to use statin drugs acutely for heart attacks. They were designed for the long-term to lower cholesterol and prevent heart attacks. Now we know that statins work not just to lower lipid levels, but they have an acute anti-inflammatory effect that acutely lowers coronary risk. These results amount to an amazing improvement and partially explains — in addition to reducing risk factors such as smoking and hypertension — why cardiac mortality has markedly decreased over the years. Everyone in the E.R. needs to have these acute interventions memorized; they are the new gold-standard of care for acute coronary occlusion.”