Heart attack patients not always receiving lowest-risk care


The most at-risk heart patients often receive the most high risk treatment for their condition, according to researchers from the Perelman School of Medicine at the University of Pennsylvania.

More than 375,000 Americans each year experience a heart attack, during which blood flow to a part of the heart is impeded by blocked arteries. Physicians often treat patients with stents, which prop open the arteries to allow blood to flow again. They use two approaches to place stents: transradial, or entry of the catheter which delivers the stent through the wrist, or transfemoral, in which the catheter is placed through the groin.

In a comparison of bleeding complications and mortality between the two approaches, researchers from the Perelman School of Medicine at the University of Pennsylvania found that those at risk for more bleeding were often treated with a riskier procedure - the transfemoral approach - a demonstration of the so-called risk-treatment paradox. The findings, from the largest study of its kind, are detailed in the Journal of the American College of Cardiology: Cardiovascular Interventions.

The subject of the study, known as rescue percutaneous coronary intervention (PCI), is performed when a patient's heart attack has not subsided after being treated with powerful clot-busting medications.

"We were surprised to see how few of these rescue PCI cases were approached with transradial access, given the increase in bleeding one might expect when performing a procedure on a patient who recently received thrombolytic therapy," said the study's senior author, Dr Jay Giri, an assistant professor of Clinical Cardiovascular Medicine.

“Even more interesting was the finding that among the group studied, patients at the highest risk for bleeding - those who would benefit most from transradial access - were least likely to receive that procedure. This counterintuitive finding is a demonstration of the 'risk-treatment paradox,' showing that doctors in these cases made treatment decisions based on what they are most comfortable with rather than what is best for the patient."

Perelman School of Medicine, University of Pennsylvania, Dr Jay Giri, US