In severe heart attacks 'every minute counts'
14th February 2018 – Every minute counts in getting treatment for the most serious type of heart attack, new research confirms.
A study in the European Heart Journal found that the number of deaths of people with ST-segment elevation myocardial infarction (STEMI) climb rapidly in tandem with delays between a patient's first contact with a healthcare professional and effective hospital treatment.
Experts say the importance of these findings should not be underestimated.
Myocardial infarction is the medical term for a heart attack. There are 2 main types of heart attack - NSTEMI and STEMI. Both result in serious damage to the heart muscles.
NSTEMI, which is more common, is a partial blockage of 1 or more of the coronary arteries that supplies oxygenated blood to the heart muscle.
STEMI is a total blockage of 1 of the coronary arteries and can lead to cardiogenic shock in which the heart is suddenly unable to pump enough blood to meet the body's needs.
'Door to balloon'
Treatment for STEMI involves percutaneous coronary intervention (PCI) in which a balloon catheter is inserted to widen the blocked artery and restore blood flow. The time taken between a patient's initial clinical assessment and this treatment is known to be critical to their chances of survival and recovery and is known as 'door to balloon'.
The latest research, led by St Bernward Hospital at Hildesheim, Germany, involved 12,675 patients with STEMI who were taken to hospital by ambulance.
The team found that 1 death in every 12 patients could be prevented if they were treated within the recommended time of less than 90 minutes. A fifth of all patients who received later PCI – between 150 and 180 minutes – died.
In an accompanying editorial, Professor William Wijns of the National University of Ireland and Professor Christoph Naber of University Hospital Essen, Germany, write: "The present work demonstrates that time matters even more than we used to think, especially in high-risk patients who still have poor outcomes".
They say the findings "call for immediate action".
These views are echoed by the British Heart Foundation. Its medical director, Professor Sir Nilesh Samani, says in an emailed comment: "Research has shown that an increase in the use of PCI has significantly contributed to improved heart attack survival in the UK. However, although heart attack survival rates are improving, heart attacks still kill roughly 1 person every 18 minutes.
"This new study clearly shows that every minute counts when it comes to treating heart attack patients.
"The quicker we can diagnose people and offer them interventions like PCI, the more lives that we will save. This is particularly true for those who are more seriously ill. It’s absolutely vital that health systems review how heart attack patients are diagnosed and treated, to ensure this happens in the shortest possible time."