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ATLANTA, G.A. -- Duke University Medical Center researchers
say a new heart attack treatment may hold promise: Give
patients a quick cocktail of drugs that dissolves clots and
stops them from reforming, and an hour later, perform an
angioplasty to clear plaque from heart arteries that are now
open.

This strategy - dubbed "facilitated angioplasty" - appears
to offer a better outcome than thrombolytic treatment
("clot-busting" drugs) or angioplasty alone, or even medical
therapy followed by angioplasty within several days, according
to Duke cardiologist Dr. E. Magnus Ohman.

Overall results of the 528-patient SPEED trial, which stands
for "Strategies for Patency Enhancement in the Emergency
Department," are being prepared for publication. Ohman and his
group, however, prepared results of a secondary analysis that
looked at the effectiveness of facilitated angioplasty in 323
of their patients.

"We have seen some dramatic outcomes in this particular
subgroup of study patients," said Ohman, the study's leader.
"This seems to be a fast, safe way to open clogged arteries in
patients having a heart attack, and should be studied more
extensively."

Coinvestigator Dr. Howard Herrmann, from the University of
Pennsylvania, prepared the results of the analysis for
presentation Monday at the American Heart
Association's annual scientific sessions.

In SPEED, patients having a heart attack were treated within
60 to 90 minutes after arriving at one of the 61 participating
hospitals in 14 countries. They were first given two doses of
reteplase, a drug that breaks up blood clots, and a loading
dose and infusion of abciximab, which prevents platelets from
clumping to form new clots. Both drugs are approved for use in
the United States, although their combination use is still in
the early stages of testing.

In the subgroup in question, the drug cocktail was followed
an hour later by angioplasty, a procedure that presses plaque
obstructions against the artery wall by inflating a small
balloon from a catheter. Then, in most patients, a small
girder-like stent was implanted into the artery wall to keep
the artery open.

Ohman, Herrmann and their team of researchers found that 30
days after the heart attack, 16 percent of patients who did not
have facilitated angioplasty had either died, had another heart
attack, or had an urgent procedure to reopen the artery,
compared with 5.6 percent of patients who had facilitated
angioplasty.

According to Herrmann, the rate of clinical success -
defined as freedom from death, another heart attack, an urgent
cardiac procedure and bleeding - was 85 percent percent in the
facilitated-angioplasty group and 70 percent for other
patients. "There appear to be many potential benefits to using
this combination strategy to facilitate an early angioplasty,"
he said.

"Unlike many treatments, facilitated angioplasty takes care
of both clots and plaque," said Ohman. Cardiologists typically
treat heart attacks with either thrombolytic drugs, such as
reteplase, to dissolve offending clots, or primary angioplasty,
to clear the plaque producing the heart attack. They don't
often use both since studies from the 1980s showed patients who
had both treatments in quick succession fared worse. "But that
was before we had a platelet inhibitor to add to the
clot-busting drugs," Ohman added. "These agents prevent
platelets from aggregating, which would otherwise mean more
clots."

Until now, physicians did not know whether using all three
treatments together (reteplase, abciximab, and angioplasty)
would increase the risk of bleeding. In fact, there was a
reduced need for blood transfusion and a trend toward less
bleeding in patients who received facilitated angioplasty,
Herrmann said.

"This triple-threat therapy provides an exciting area for
exploration," Ohman said in an interview. "We hope to confirm
these promising results in a much larger population."