The most severe type of heart attack is known as an ST elevation myocardial infarction (STEMI). If symptoms started less than 12 hours ago there are two treatment options. The first is to give (drip) a clot buster medication, (thrombolytic), through an IV. The second is to transfer (ship) patients to a cardiac catheterization laboratory (cath lab) for angiography and a possible balloon and stent procedure, known as percutaneous coronary intervention (PCI).
The Clot Buster (Thrombolytic): The Drip Approach
Thrombolytic given quickly in the emergency department it is an acceptable alternative to cath lab transfer. The American College of Cardiology suggests that a thrombolytic be given within 30 minutes of a patient’s arrival in the emergency room and a balloon and stent procedure be started within 90 minutes.
While all emergency rooms in the United States have thrombolytic medication available, very few have cath labs in the same hospital. A critical decision by emergency room staff in a hospital without a cath lab is whether to quickly give the thrombolytic medication or to transfer patients with an STEMI to a different hospital’s cath lab.
The Ballon and Stent Procedure (Agiography/Angioplasty/Stenting): The Ship Approach
Most cardiologists prefer the balloon and stent procedure to thrombolytic therapy. Unfortunately, transfers often take longer than 90 minutes making thrombolytic therapy the only option. It is controversial where patients picked up by an ambulance with an STEMI should be taken. A hospital with a cath lab may be further away than the local hospital which has only thrombolytics available. The arguments for and against this approach include accuracy of diagnosis by ambulance crews, safety of delaying physician care by driving to further hospitals, and revenue loss by non-cath lab hospitals if sicker patients are taken elsewhere.
Opening a Clogged Artery: The Sooner the Better
Although opening a clogged coronary artery can be effective up to 12 hours into a heart attack, you should not delay calling 911. The greatest benefit of both thrombolytics and angioplasty is within the first few hours after symptoms start.
Providing the best possible patient care is the priority. If indeed PCI is better than thrombolytic therapy, the medical community needs to improve diagnostic tools, ambulance-physician communication, and expedited transfer to appropriate cath lab hospitals. What really matters for you as the patient is getting the artery opened as soon as possible. You must get to a hospital immediately if you suspect a heart attack. The doctors and nurses will determine the best treatment approach for your specific case.