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Duke Research News

Half of STEMI Heart Attack Patients May Have Additional Clogged Arteries A blocked artery causes a deadly kind

Patel, M.D., director of Interventional

compared to a 1.9 percent death rate

of heart attack known as ST elevation

Cardiology and Cardiac Catheterization

among those who had a single blockage.

myocardial infarction (STEMI), and a rapid

Labs at Duke University Health System.

response to clear the blockage saves lives.

“We found that more than half of the

“The current thinking among cardiologist

28,000 patient scans we analyzed showed

is that it is dangerous to treat these other

But in more than half of cases studied

at least one additional blocked artery, and

blockages at the same time as treating the

recently by Duke Medicine researchers,

about 19 percent had blockages in all three

artery that created the heart attack,” Dr.

one or both of the patient’s other arteries

arteries.”

Patel said. “There has been a sense that the patient is healing and it may damage

were also obstructed, raising questions about whether and when additional

In their retrospective study, Dr. Patel and

the heart. But we haven’t had a good idea

procedures might be undertaken.

colleagues analyzed eight large, interna-

of the risks or the potential benefits.

tional clinical trials of patients who sufIn a study published in

fered a STEMI heart attack. These serious

“Our study has established that these

the Nov. 19 issue of the

heart attacks strike nearly 250,000 people

additional blockages appear to be very

Journal of the Ameri-

in the United States a year, according to

common, and these patients seem to do

can Medical Associa-

the American Heart Association.

worse, so we need additional studies to confirm these findings and then determine

tion, Duke researchers and their colleagues

The researchers analyzed angiograms for

when and how best to open up the

report the first large

the patients to quantify how many had

additional arteries to restore blood flow,”

analysis of how often

additional blockages in one of the other

Dr. Patel said.

these secondary block-

three arteries of the heart. While it has long

ages occur, along with evidence that they

been assumed that many patients would

In addition to Dr. Patel, study authors

lead to worse outcomes.

have additional blockages, the research

include Duk-Woo Park, Robert M. Clare,

team’s finding that 52.8 percent of patients

Phillip J. Schulte, Karen S. Pieper, Linda

The findings provide fodder for additional

had more than one blockage indicates the

K. Shaw, Robert M. Califf, E. Magnus

studies to determine whether opening all

prevalence.

Ohman, Frans Van de Werf, Sameer Hirji,

Manesh Patel, M.D.

Robert A. Harrington, Paul W. Armstrong,

the blocked arteries – either at the same time or within a few days or weeks –

Further, the research team found that

Christopher B. Granger and Myung-Ho

should become a standard procedure.

additional clogged arteries were associated

Jeong.

with a small but significant increase in “We assumed this was a common problem,

death rates. Patients with more than one

The John Bush Simson Fund provided

but it has not been well understood or

blocked artery had a 3.3 percent mortality

support for the study.

quantified,” said senior author Manesh

rate within 30 days of the heart attack,

Older Breast Cancer Patients Still Get Radiation Despite Limited Benefit Women over the age of 70 who have cer-

The study suggests that doctors and

“The onus is on physicians to critically

tain early-stage breast cancers overwhelm-

patients may find it difficult to withhold

analyze data to shape our treatment rec-

ingly receive radiation therapy despite

treatment previously considered standard

ommendations for patients, weighing the

published evidence that the treatment has

of care, even in the setting of high-quality

potential toxicities of treatment against

limited benefit, researchers at Duke Medi-

data demonstrating that the advantages are

clinical benefit,” said Rachel Blitzblau,

cine report.

small.

M.D., Ph.D., the Butler Harris Assistant Professor of Radiation Oncology at Duke

14

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