This pilot study was set up with support from Heart Research Australia. Heart-attack victims are taken direct to a 24/7 emergency service at Sydney's Royal North Shore Hospital or Westmead Hospital.
Ongoing since 1997, the program is known as SALAMI (Stents as an Alternative to Lytic therapy in Acute Myocardial Infarction).
Using a stent (a small piece of steel mesh), cardiologists open up blocked arteries 100 minutes earlier than usual. Patients leave hospital within three days, and are soon back at work, with minimal heart damage.
Saving time: stents instead of drugs
Time is muscle, and the stenting process saves heart muscle from irreversible damage.
Back in 1997 the standard treatment for opening arteries was the use of slow-acting, clot-busting drugs (known as lytic therapy). These took time to work, and could cause serious complications.
Professor Helge Rasmussen and Dr Gregory Nelson, both interventionist cardiologists at Royal North Shore Hospital, realised that mechanical unblocking of coronary arteries (with balloon catheters or stents) was likely to be a superior, and faster, treatment.
To test their theories they set up a 24/7 emergency service for heart attack victims. Stents were inserted to open the artery and allow blood to reach the heart. This is done in an emergency operation known as infarct angioplasty.
Safer, faster treatment
Infarct angioplasty proved a much safer and more effective treatment. As a result, clot-busting drugs have not been used on the Royal North Shore campus since 1997.
For the treatment to have maximum impact, it should happen as soon as possible after the onset of a heart attack. Treatment within two hours from the start of chest pain gives the best possible result.
Major hospitals rather than local
Infarct angioplasty is best performed in a regional heart attack centre. The drop in deaths during this study was achieved despite patients often travelling further than their nearest hospital, to be treated at Royal North Shore or Westmead Hospital.
Critical delays at local centres
Before the study, most heart attack patients in the Northern Sydney or Western Sydney Area Health Regions were taken by ambulance to the nearest district hospital for diagnosis. While these hospitals are closer to the patient's location, they lack the facilities and specialist staff to mechanically unblock an artery.
Patients would then be transferred to Royal North Shore or Westmead, facing significant delays before treatment.
Better outcomes at major centres
The outcomes of treatment are related to the volume of procedures done in any one unit. The more operations that are done, the better the outcomes – practice makes perfect.