'Most heart events avoidable'

TNN | Sep 19, 2011, 12.46AM IST

PUNE: Every year 17.1 million lives are claimed across the world by cardiovascular diseases, with 82 per cent of deaths occurring in low- and middle-income countries. Majority of these deaths could be prevented through steps such as eating a healthy diet, regular physical activity and avoiding tobacco, cardiologist Shireesh Sathe, director of cardiology department at Deenanath Mangeshkar Hospital (DMH), said at a press conference here on Friday.


"However, not all heart events are preventable. If one suspects a family member of having a heart attack (myocardial infraction) or stroke, medical help should be sought immediately. Over 70 per cent of all cardiac and breathing emergencies occur at home when a family member is available to help a victim. There are treatments available through which the lives of our loved ones can be saved," said Sathe. He was speaking ahead of the World Heart Day that falls on September 29. 'One World, One Home and One Heart' is this year's theme.


Emphasising on the importance of primary angioplasty, Sathe said, "Primary angioplasty in myocardial infarction is the safe and effective treatment for heart attack patients in which chances of survival are higher. It is the preferred treatment for myocardial infarction if it can be provided promptly, with patients being taken directly to the catheter laboratory of the nearest heart attack centre rather than to a local hospital or an emergency care centre."


Compared to clot-busting medication (thrombolytic therapy), primary angioplasty results in a lower mortality. Besides, the rates of readmission for heart failure and ischaemia are lower in patients from the angioplasty group than in patients treated with medicine like streptokinase, Sathe said.


"Patients undergone clot-busting medication will have to undergo coronary angiography and angioplasty within next three to 24 hours, which is called pharmaco-invasive therapy. The success rate of opening the vessels is 65% to 75% in thrombolytic therapy. Again, those who are successfully thrombolised have 20% incidence of a recurrence of heart attack within three to five days. That's the reason why even successful thrombolysis should be followed by angioplasty within 24 hours," Sathe said.


Primary angioplasty is the best option for heart attack. Pharmacoinvasive therapy (lyse now and stent later) is the second best option. But thrombolytic therapy alone is not a good option, Sathe said.


The reduction in death or non-fatal reinfarction after angioplasty, compared with thrombolysis, is even more striking. With respect to safety, stroke was reduced from 2% with thrombolysis to 0.7% with angioplasty, he added.


When asked how many patients of angioplasty group encounter in-stent thrombosis, Sathe said, "With modern medicines and modern stents, the incidence of in-stent thrombosis is close to zero per cent now. However, even in a country like India where large number of angioplasties are performed, thrombolytic therapy is still used often. This is caused by issues such as logistical difficulties, reimbursement, variability of angioplasty results and safety and feasibility of inter-hospital transportation."
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