St. Mary’s Regional Cardiac Centre was part of an international study featured recently in the New England Journal of Medicine, which settled a long-standing debate on how best to treat heart attack patients.
The study of more than 4,100 patients from 30 countries over seven years found that opening clogged arteries with stents, beyond the one that caused the heart attack, is better than treating the additional blockages with medication alone.
The COMPLETE Trial found a 26% reduction in the risk for recurrent heart attacks when the additional blockages were opened with angioplasty and stents. There was no significant increase in stroke, major, bleeding or other complications from the procedure.
“St. Mary’s is very proud to have been one of the top enrolling Canadian hospitals in this very important study with 62 of our patients participating,” says Dr. Umjeet Jolly, a Cardiac Electrophysiolgist and Research Lead at St. Mary’s. “These patients are excited to have helped set a new standard that will improve patient outcomes around the world.”
During angioplasty stents are delivered by a balloon catheter that is passed through an artery in the patient’s groin or wrist into the heart. The balloon is inflated to open the blockage, restoring the blood supply to the heart and organs, and the stent is left behind to keep it open. St. Mary’s performs nearly 4400 cardiac catheterization procedures per year to diagnose and treat coronary artery disease, as well as 1,800 angioplasty procedures.
Of heart attack patients, about half have additional blockages. Since no definitive proof of which treatment approach was best prior to the findings of the COMPLETE trial, some doctors opted to open them with stents. Others chose to prescribe medication, with recurring testing and monitoring. The latter approach could be unsettling for patients fearful of having another heart attack.
“For some patients the uncertainty led to a reduction in their overall health,” says Dr. Jolly. Now patients with a secondary blockage of 70 per cent or more will receive additional stents while still at St. Mary’s or are booked to receive them within 45 days of their heart attack.
“It helps improve patient outcomes and gives patients peace of mind to know that the problem has been dealt with,” Dr. Jolly says. There is also potential for financial savings with a reduced need for repeat testing and fewer trips to the emergency department or readmission to hospital.
Dr. Jolly says the general public may not be aware that the St. Mary’s Regional Cardiac Care Centre is actively involved in research. Dr. Hahn Hoe Kim, an interventional cardiologist, was the principle lead investigator at St. Mary’s for the COMPLETE Trial. While the trial is now closed, the cardiac centre is currently participating in 18 international studies with four more about to begin.