"The Golden Hour"

By Dr. W. Gifford Jones

January 24, 1993

Everyone has heard of T.V.'s "Golden Girls"! But are readers aware of the heart's "Golden Hour"? These precious 60 minutes can mean the difference between life and death. Or the difference between living an active life or that of an invalid.

Heart attack remains North America's number one killer. Every year about 1.5 million North Americans experience crushing coronary chest pain. It results in 600,000 deaths of which 300,000 die before reaching the hospital.

Several years ago I reported that researchers had discovered a new drug, TPA, which acts like Drano to unplug coronary arteries.

Plugged coronary vessels, like clogged toilets, cause more trouble the longer they're plugged. The result may be sudden death. If patients survive, the longer the blood supply is obstructed, the greater the damage to the heart muscle. Heart failure occurs when a major portion of cardiac muscle has been badly scarred.

"Cardiac Drano", has been used only when patients have been admitted to the hospital's emergency department. Several drugs have been used for this purpose with encouraging results.

Prompt use of TPA removes the blood clot in about 70 per cent of coronary arteries. Quick dissolution of the obstruction saves about half of the patients from suffering damage to the heart muscle. It also results in a 50 per cent reduction in mortality.

Time is an enormous factor in the effectiveness of "Cardiac Drano". The drug must be given within the first two to three hours. If administered five to six hours after the clot has formed it's like closing the barn door after the horse has escaped.

The obvious question is would this clot-clearing drug be even more beneficial if given by trained ambulance attendants or physicians prior to hospital admission? Two studies, one done in the U.S. and the other in Europe, have answered this question.

Dr. W. Douglas, Director of the U.S. study, recently reported his findings to the 41st Annual Scientific Session of the American College of Cardiology meeting in Dallas, Texas.

Patients who received treatment within the first hour were fortunate. The mortality rate decreased from 10 to one per cent and damage to the heart muscle was cut in half. But after this "Golden Hour" the death rate and size of the damaged heart muscle rapidly increased.Ô 0*0*0* Another study done at the University of Washington had comparable results. Dr. W. Douglas Weaver, Associate Professor of medicine reported that there was no evidence of heart attack damage in 40 per cent of patients treated within the first hour.

The Washington study demonstrated another unexpected benefit. The pre©hospital treatment of heart attack victims with clotªdissolving drugs speeded up the treatment of other coronary patients who were initially seen in the hospital's emergency room. The message got through to everyone that speed was essential.

Dr. Pierre Boissel of Lyon, France, also reported similar findings. The European study was larger, consisting of 5,454 patients who received another type of Drano called anistreplase.

The European study involved 16 countries, but 66 per cent of patients in the study were French, as France had the best mobile network of physicians and nurses in ambulances. These mobile units decreased the time of injection of "Cardiac Drano" by 56 minutes over those treated in hospital.

The pre-hospital use of these clot-clearing drugs appears to be relatively safe. Dr. Boissel reported that 1.5 per cent of patients developed a stroke, 0.5 per cent cerebral bleeding and 7.0 per cent abnormal changes in the heart's rhythm. But hospital patients given anistreplase had the same number of these complications.

These studies answered another question which worried doctors. Would patients with sudden chest pain be given "Cardiac Drano" who were not actually experiencing a heart attack? But the diagnosis of coronary attack was confirmed in 94 per cent of patients in the European study and 98 per cent of patients in the U.S. study.

Suppose you have a heart attack at the cottage many miles from the nearest medical help. I suggested four years ago that in this situation self-medication might save your life. But this is still a risky approach for the laity.

Self-medication could end your days if the pain you were suffering was actually due to a bleeding stomach ulcer. And you may waste several thousand dollars if the chest pain is due to indigestion.

Pre-hospital use of "Cardiac Drano" isn't the be-all and end-all in the prevention of coronary deaths. Patients will still die regardless of being given this treatment. And unfortunately these drugs cannot remove the underlying atherosclerosis that helped form the blood clots. But they are one of the major cardiovascular breakthroughs of this decade.

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones

Canada Free Press, CFP Editor Judi McLeod