By Camille Ramlukan and Tracey Brown
Recently, the trend for preventing and treating heart attacks has evolved toward the expanded use of percutaneous coronary intervention, or PCI. St. Mary’s General Hospital in Kitchener now offers this intervention as a treatment option for patients. St. Mary’s began offering diagnostic cardiac catheterizations in February 2001, and when the Regional Cardiac Care Centre expanded in July 2003, it became a full service program, offering cardiac catheterizations, PCI and cardiac surgery. Over the two-month period that followed St. Mary’s began offering primary PCI, which is now available on an around-the-clock basis to the community.
Historically, symptoms of a heart attack were treated using blood thinners. More proactive ways were then introduced to treat heart attacks. This included the use of thrombolytics (clot-busting drugs), which are most effective when administered within six hours of the onset of symptoms. Today, primary PCI, if available in a timely fashion, is the treatment of choice, and has provided a more effective alternative for those who are not eligible to receive thrombolytics. “In a heart attack, ‘time is muscle’. The more immediate the intervention of PCI, greater is the potential for saving healthy cardiac muscle,” says Tracey Brown, regional cardiac care co-ordinator for Angioplasty.
Recent studies, PAMI and GUSTO IIb, have shown that primary PCI can successfully restore blood flow to the affected artery in 95% of patients. Treatment with thrombolytics alone restores blood flow in only 50-60 % of patients. These studies have also indicated that other benefits of primary PCI, when compared to thrombolytics, include lower mortality rates at six months or less, lower rates of non-fatal reinfarction (heart attacks) and recurrent ischemia (chest pains), lower stroke rates, shorter hospital stays and reduced hospital re-admission rates, and lower rates of repeat intervention.
To be most effective a primary PCI must be performed within 90 minutes from the patient’s arrival in the emergency ward. If a patient’s travel-time exceeds this, he or she should receive thrombolytic therapy, if indicated. If required they can then go on to have what is known as a “facilitated” or “rescue” PCI upon arrival at St. Mary’s. At present, the average time to transfer a patient from St. Mary’s, or other hospital emergency departments in our region, to the catheterization suite for a primary PCI is 72 minutes.
“The ability to perform primary PCI on a twenty-four hour basis requires complex organization and the firm commitment of all of the health care professionals involved. A highly-trained catheterization lab staff and our interventionalists bears testimony to the phenomenal commitment of St. Mary’s in providing the best patient care possible to the communities we serve,” says Brown. St. Mary’s three Cardiac Interventionalists are Dr Hahn Hoe Kim, Dr. Danielle Leddy, and Dr. Suzanne Renner. Dr. Michael Theale from Calgary will join the team in July.
St. Mary’s also offers drug eluting stents to patients at high risk of re-occurrence who undergo a PCI. A stent is a mesh-like cylinder inserted using an angioplasty balloon. After the balloon has been inflated and deflated, compressing the blockage against the artery wall, the stent is deployed at the blockage site. It remains in place after the balloon has been removed and helps prevent the blockage from re-occluding the artery. This use of drug eluting stents has led to decreases in the occurrence of re-occlusion in the treated artery.
As a treatment for heart attacks, primary PCI leads to improved patient outcomes. Primary PCI can also limit the size of heart attacks, thus saving heart muscle. The use of the drug eluting stents in PCI for patients at high risk of re-occurrence allows St. Mary’s to provide services that will offer maximum benefits to the patient. By embracing the findings of current research, St. Mary’s Cardiac Care Centre shows its dedication to the health of those in the region, by making current research findings a clinical reality.
Camille Ramlukan is the communications coordinator at St. Mary’s General Hospital. Tracey Brown is the coordinator for Angioplasty for the St. Mary’s Regional Cardiac Care Centre.