A new treatment for heart attack will soon be available for emergency teams and the emergency ambulance

October 30, 2013

A new strategy for emergency anticoagulant treatment for patients with acute myocardial infarction has been put in place by a team led by Philippe-Gabriel Steg at Inserm Unit 698 (Haemostasis, Bioengineering, Immunopathology and Cardiovascular Remodelling), at Hôpital Bichat, AP-HP, Université Paris Diderot). These results from the EUROMAX clinical trial are published in The New England Journal of Medicine.

Myocardial infarction, commonly called "heart attack," remains the leading cause of death worldwide, and affects nearly 100,000 individuals a year in France. The reference treatment is urgent dilation of the arteries to enable the blood to circulate to the heart (This medical procedure is known as primary angioplasty). Angioplasty requires injectable anticoagulant treatment for which several options are available.

An international team led by Philippe-Gabriel Steg at Inserm Unit 698 (Haemostasis, Bioengineering, Immunopathology and Cardiovascular Remodelling), at Hôpital Bichat, AP-HP, Université Paris Diderot) has just reported the results of a large international clinical trial carried out in 9 European countries, on nearly 2,200 patients, testing the administration of anticoagulant treatment prior to arrival in hospital by emergency teams and the emergency ambulance service, and comparing the two strategies, in The New England Journal of Medicine . The first is based on heparin (traditional treatment), the other on a more specific anticoagulant, bivalirudin. One of the main drawbacks of these anticoagulant treatments is the risk of associated haemorrhage. "By dilating the arteries, we also thin the blood, with the risk of uncontrolled bleeding if haemorrhage occurs," explains Philippe-Gabriel Steg.

After 30 days of monitoring, bivalirudin reduced the risk of death or serious bleeding by 8.5 to 5.1% and the risk of death, myocardial infarction or major bleed by 9.2 to 6.6%, compared with the strategy using heparin.

This benefit was mainly linked to the reduction in serious bleeding, at the cost of an increased risk of stent thrombosis . "The benefits are robust and consistent for all sub-groups tested, and in particular, consistent regardless of the type of oral anti-clotting treatment or route of arterial access used for angioplasty (via the radial or femoral artery)," explains Philippe-Gabriel Steg.

These results open up the way to using bivalirudin as an anticoagulant at the pre-hospital phase of myocardial infarction in patients being urgently transferred. They represent progress in the treatment of myocardial infarction that can be immediately used.
-end-
The EUROMAX trial was conducted with the support of The Medicines Company. It is registered in Clinical Trials.gov, under the reference NCT01087723.

Sources

Bivalirudin Started During Emergency Transport for Primary PCI
Steg PG, van 't Hof A, Hamm CW, Clemmensen P, Lapostolle F, Coste P, Ten Berg J, Van Grunsven P, Eggink GJ, Nibbe L, Zeymer U, Campo dell' Orto M, Nef H, Steinmetz J, Soulat L, Huber K, Deliargyris EN, Bernstein D, Schuette D, Prats J, Clayton T, Pocock S, Hamon M, Goldstein P, for the EUROMAX Investigators*

The New England Journal of Medicine 30 October 2013

Investigator contact

Philippe-Gabriel Steg
Inserm Unit 698, "Haemostasis, Bioengineering, Immunopathology and Cardiovascular Remodelling"
Cardiologie, Département Hospitalo-Universitaire FIRE, Hôpital Bichat, France,
E-mail: gabriel.steg@bch.aphp.fr.
Tel.: +33 1 40 25 86 69 //(0)6 07 24 62 24

Attention overseas investigators (San Francisco - 8-hour time difference) to present the trial results at the TCT conference. If you call at 16:00, Paris time, it will be 8:00 for the investigator.

Press contact


presse@inserm.fr

INSERM (Institut national de la santé et de la recherche médicale)

Related Heart Attack Articles from Brightsurf:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

Molecular imaging identifies link between heart and kidney inflammation after heart attack
Whole body positron emission tomography (PET) has, for the first time, illustrated the existence of inter-organ communication between the heart and kidneys via the immune system following acute myocardial infarction.

Muscle protein abundant in the heart plays key role in blood clotting during heart attack
A prevalent heart protein known as cardiac myosin, which is released into the body when a person suffers a heart attack, can cause blood to thicken or clot--worsening damage to heart tissue, a new study shows.

New target identified for repairing the heart after heart attack
An immune cell is shown for the first time to be involved in creating the scar that repairs the heart after damage.

Heart cells respond to heart attack and increase the chance of survival
The heart of humans and mice does not completely recover after a heart attack.

A simple method to improve heart-attack repair using stem cell-derived heart muscle cells
The heart cannot regenerate muscle after a heart attack, and this can lead to lethal heart failure.

Mount Sinai discovers placental stem cells that can regenerate heart after heart attack
Study identifies new stem cell type that can significantly improve cardiac function.

Fixing a broken heart: Exploring new ways to heal damage after a heart attack
The days immediately following a heart attack are critical for survivors' longevity and long-term healing of tissue.

Heart patch could limit muscle damage in heart attack aftermath
Guided by computer simulations, an international team of researchers has developed an adhesive patch that can provide support for damaged heart tissue, potentially reducing the stretching of heart muscle that's common after a heart attack.

How the heart sends an SOS signal to bone marrow cells after a heart attack
Exosomes are key to the SOS signal that the heart muscle sends out after a heart attack.

Read More: Heart Attack News and Heart Attack Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.