The stroke risk comes primarily from the catheter dislodging a clot in the heart and the clot finding its way to the brain. Despite extensive publicity about heart disease in this country, at least 25 percent of heart attacks go unrecognized for several days, often confused with heartburn or an upset stomach. To further confuse recognition, classic chest pain is not present in about half of people over age 70 having a heart attack. Over the next year, MCG and the Augusta VA will enroll about 50 patients in the study to help determine whether catheterization during which a catheter is inserted into the arteries of the heart and contrast medium is injected to study blood flow and heart function benefits this common subset of heart patients or just increases their stroke risk and medical costs. Participants will have a non-invasive study called a myocardial perfusion image in which tiny amounts of radioactive tracers are used to assess the heart's blood flow and muscle viability.
Doctors use that image to quantify how much of the heart has poor blood flow.
Someone with significant viable heart muscle that likely will succumb to the next attack, likely would benefit from catheterization, Dr. Robinson said. Although, some previous data suggest that even in these patients, aggressive medical therapy may be as beneficial as catheterization, but with reduced risk, he said. Those in the lowest risk group whose hearts have sustained minimal reduction of their ability to pump blood out to the body will receive aggressive medical therapy. Those who sustained the most damage will immediately receive catheterization in an attempt to revascularize their ailing hearts. Follow-up perfusion scans at six weeks will help determine which approach best reduced ischemia with the least risk.