Key Questions
Is primary angioplasty better than thrombolysis for heart attacks?
Primary angioplasty may offer a small benefit over thrombolysis, but the evidence is not conclusive. The advantage depends on how quickly angioplasty can be performed. Thrombolysis remains an acceptable treatment option, especially when angioplasty would cause significant delays.
Should all patients with acute coronary syndromes get invasive procedures?
Not all patients with acute coronary syndromes need invasive procedures. The benefits of routine invasive management are modest. A more selective approach based on individual patient risk may be appropriate.
How does time affect heart attack treatment outcomes?
Time is critical in heart attack treatment. Each hour of delay reduces the benefits of reperfusion therapy. The advantage of primary angioplasty over thrombolysis decreases when door-to-balloon time exceeds door-to-needle time by 60 minutes.
Are invasive heart procedures cost-effective?
The cost-effectiveness of routine invasive procedures for acute coronary syndromes is questionable. Higher rates of invasive procedures do not always lead to better outcomes. The optimal rate of invasive intervention may be 20-30% of patients.
What are the risks of invasive heart procedures?
Invasive heart procedures carry risks such as bleeding complications. Recent studies show increased short-term mortality with routine invasive strategies. The benefits must be weighed against these risks for each patient.
