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
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
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
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,
M.D., Ph.D., the Butler Harris Assistant Professor of Radiation Oncology at Duke
The Triangle Physician
The Triangle Physician Dec2014/ January 2015