> http://www.uthouston.edu/forMedia/newsreleases/nr2003/heartattack.htm > > > Study Evaluates Quick Advanced Care for Heart Attack > > HOUSTON -- The PATCAR trial, a Houston-led pilot > study in Texas and Florida, > will test a new standard of aggressive care for > heart attack patients and > lay the groundwork for re-thinking emergency > treatment for the 1.5 million > Americans stricken each year. > > About 500,000 Americans die annually from acute > heart attacks - sudden > blockage of coronary arteries known as acute > myocardial infarction. > > "In contrast to the specialized system that has been > developed in most > communities for the treatment of critically injured > trauma patients, there > is no uniform approach to treating heart attacks," > said principal > investigator Richard Smalling, M.D., Ph.D., director > of the Division of > Cardiology at The University of Texas Medical School > at Houston and director > of the cardiac catheterization lab at Memorial > Hermann Hospital. "Despite > the clear-cut advantage of aggressive treatment over > conservative therapy, > management of acute myocardial infarction in the > United States remains > fairly arbitrary. Our objective through this study > is to define the optimal > mode of treatment of acute heart attack patients." > > The 18-month study in Houston, Miami, Fort > Lauderdale, Fla., and Lubbock, > Texas, is expected to lead to a large-scale clinical > trial involving 20 > institutions nationally. Cardiologists and emergency > room physicians > associated with the UT Medical School at Houston, > Memorial Hermann, Houston > EMS, and the Houston Chapter of the American Heart > Association announced the > study, which they expect to launch March 17, at a > news conference today at > Memorial Hermann. > > Study hospitals and emergency medical services will > team up to provide > faster evaluation and care of heart attack victims > in the field. Study > patients will receive a dose of clot-busting drugs > (thrombolytics) -- either > from EMS personnel in the urban study areas or at a > community hospital in > the rural study areas -- before being transported to > a Level 1 > Cardiovascular Center with advanced capabilities for > treating heart attacks. > > The study will evaluate the mortality and incidence > of second heart attacks > among patients who then receive one of two courses > of treatment. One group > will receive a second dose of clot-busting drugs and > then be admitted to a > cardiovascular intensive care unit, which is how > most heart attack patients > are treated today. The second group will go directly > to the Cardiac > Catheterization laboratory where they will receive > an emergency angiogram of > the heart's arteries and an emergency balloon > angioplasty or stent surgery > to open the blocked artery causing the heart attack. > > The six-month mortality in heart attack patients > across the country, when > treated with either standard clot-busting therapy or > coronary angioplasty > alone, ranges between 6 and 10 percent. Smalling and > colleagues believe a > coordinated, aggressive strategy for treating heart > attack patients, which > combines the advantage of early administration of a > clot-buster with > transportation to specially designated Level I > Cardiovascular Centers for > immediate angiography and stenting of the heart > attack artery, will lower > the six-month mortality to 2 to 4 percent. > > "If this strategy proves to be successful and were > to be implemented across > the country it has the potential to save > approximately 500 lives per day in > the United States alone, which is the equivalent of > preventing two jumbo jet > crashes per day," Smalling said. > > Other physician investigators participating in the > pilot phase of this study > in Houston include David Persse, M.D., physician > director of EMS for the > City of Houston Fire Department; Richard Bradley, > M.D., assistant professor > of emergency medicine at the UT Medical School, > medical director for the > Memorial Hermann Hospital Emergency Center, and > assistant medical director > of EMS for the Houston Fire Department; and David > Robinson, M.D., assistant > professor, research director and vice chair of > emergency medicine at the UT > Medical School and medical director of the > Diagnostic Observation Center at > Memorial Hermann Hospital. Also participating are > Donald Rosenberg, M.D., > University of Miami School of Medicine in Miami; > Howard Bush, M.D., > Cleveland Clinic Florida in Fort Lauderdale; and > Charles Wilkins, M.D., at > Covenant Health Systems in Lubbock. > > All of the associated cardiac centers have a high > volume of major heart > attack patients, in field 12-lead ECG capability, > and heart attack clinical > trial experience. Dr. Rosenberg's group has been > successfully giving > clot-busting drugs in Miami ambulances for more than > five years and will > help train the other centers in the pre-hospital > phase of the therapy. > > Investigators also expect the pilot study to > stimulate discussion of > certifying Level 1 Cardiovascular Centers that would > be similar to the > present certification of Level 1 Trauma Centers, > which provide swift, > advanced care to trauma victims. PATCAR, the study's > acronym, stands for > Pre-Hospital Administration of Thrombolytic Therapy > with Urgent Culprit > Artery Revascularization. >
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