Produced by the Office of Communications // December 8, 2011
Study: Heart attack patients who call 911 are sicker
Cardiologists are quick to point to statistics showing that the “door-to-balloon” treatment time for heart attack patients has dropped significantly in the past few years. But a retrospective study reveals that those who call 911 are most likely to have suffered a severe heart attack and despite receiving treatment quickly, they are still dying at unacceptable rates, say Medical School researchers.
Results from the large retrospective study were presented at the American Heart Association’s Scientific Sessions 2011 by lead author Dr. James McCarthy, assistant professor of emergency medicine and director of the Emergency Center at Memorial Hermann-Texas Medical Center.
Door-to-balloon refers to the period of time from a patient’s arrival at the hospital to when a guidewire reaches the blockage and opens the artery with the inflation of a tiny balloon.
The results of the study showed that patients who call 911 instead of transporting themselves to the emergency room arrive 30 minutes faster and have shorter door-to-balloon times (56 minutes versus 70). Unfortunately, in spite of this they are more likely to be in shock (10.7 percent versus 3.5), suffer heart failure (9.9 percent versus 6.3) by the time they get to the hospital, and more likely to die during their hospitalization (7.2 percent versus 2.4).
“Those who call an ambulance are three times more likely to die because their disease is worse. They are much sicker,” McCarthy said. “We suspect that it means they have a larger infarct (area of damage). It’s a vulnerable population that despite rapid emergency medical services (EMS) and hospital care still has higher mortality.”
Previous UTHealth research has shown that if the artery is unblocked in the first hour after a heart attack, there is minimal damage. After three hours, most of the damage has been done so UTHealth researchers have been concentrating on how to shorten that time to two hours or less.
The only way to lower the current time from symptoms to opening the artery is to treat the patient in the ambulance, McCarthy said. A year ago he presented results of a UTHealth clinical trial called Pre-Hospital Administration of Thrombolytic Therapy with Urgent Culprit Artery Revascularization (PATCAR). That trial showed that the mortality rate of patients arriving via EMS could be lowered to 2.9 percent by giving them a low dose of a clot-busting drug intravenously before they arrived at the hospital. The research was a collaboration of UTHealth, Memorial Hermann Heart & Vascular Institute-Texas Medical Center (HVI), and the Houston Fire Department.
“We know we’ve optimized the hospital system and integrated that with EMS, but for the cohort that calls 911, that’s still not enough,” he said. “We need to figure out something else.”
The researchers looked at 37,715 patients in the American College of Cardiology’s National Cardiovascular Data Registry. The presentation title is “EMS Transport of STEMI Patients Shortens Ischemic Times and is Associated with a Higher Risk Population: Results from the ACTION Registry.”
Other UTHealth/Memorial Hermann HVI presenters at the conference are Dr. Richard Smalling, professor and director of interventional cardiovascular medicine, and Dr. Manuel Munoz Reyes, interventional cardiology clinical fellow.
— Deborah Mann Lake, Office of Advancement, Media Relations
Genetic counselor wins New Leader Award
Kate Wilson, instructor in the Department of Obstetrics, Gynecology and Reproductive Sciences, received the 2011 National Society of Genetic Counselors New Leader Award at the NSGC 2011 Annual Education Conference in October in San Diego.
Nominated by her genetic counseling colleagues and awarded by the NSGC awards committee, Wilson was one of two winners of the national award, which recognizes a new genetic counselor who has shown “significant initiative in contributions to NSGC and the profession.”
“I was very honored to receive this award. The National Society of Genetic Counselors is a great organization, and it's been wonderful to be a part of NSGC,” said Wilson, who has been a genetic counselor for nearly five years.
“We are very proud of all of her work on the national level,” said Jennifer Hoskovec, assistant professor of obstetrics, gynecology, and reproductive sciences.
Wilson received her master’s degree in science in genetic counseling at the University of South Carolina and joined the Medical School in 2007.
“I enjoy working with patients and helping them understand genetics and genetic testing,” Wilson said. “It's also very rewarding to work with the UT Genetic Counseling Program and their students. I love being a part of their training and education.
“I just want to thank the other UT genetic counselors and the department of Ob/Gyn. They have been a source of constant support, and I am fortunate to work with them!”
— Darla Brown, Office of Communications, Medical School
Otorhinolaryngology residents receive research grants
Two residents in the Department of Otorhinolaryngology-Head & Neck Surgery have been awarded competitive research grants to further their studies.
Dr. Elton Lambert, a second-year resident, has received a $5,200 grant from the American Academy of Otolaryngic Allergy Foundation for “Optical Rhinometry in Non-allergic Irritant Rhinitis: A Capsaicin Challenge Study.” Lambert will explore diagnosis of non-allergic rhinitis–nasal inflammation unrelated to an allergic response, such as nasal irritation caused by various chemicals.
“The economic impact of chlorine, formaldehyde, and other occupational irritants is considerable, but there is currently no objective means of diagnosing non-allergic rhinitis,” said Dr. Amber Luong, assistant professor of otorhinolaryngology-head and neck surgery and an assistant professor of immunology at The University of Texas MD Anderson Cancer Center. “Dr. Lambert will be determining whether patients with non-allergic rhinitis can be diagnosed with a noninvasive objective test that involves challenging the nose with a small amount of capsaicin and measuring blood flow changes using optical rhinometry.”
Third-year resident Dr. Nicholas Sorrel was awarded an $8,000 grant from the American Rhinologic Society to study the antimicrobial activity of manuka honey and its potential therapeutic use in acute bacterial exacerbations of chronic rhinosinusitis (CRS). The objective of the study, entitled “Manuka Honey for Management of CRS: An in vitro and in vivo Analysis,” is to compare the effectiveness of topical irrigations with manuka honey with the results of typical management by oral antibiotics.
“Patients with CRS tend to develop acute flare-ups of their disease, which is often accompanied by an obvious presence of pus in the sinuses,” Luong said. “In CRS patients we frequently culture Staphylococcus aureus, which is thought to be the pathologic bacteria. Typical management involves oral antibiotics. However, in patients who have undergone sinus surgery, the open sinus cavities allow us an opportunity to treat these infections with topical medications. Manuka honey has shown antimicrobial activity specifically against Staphylococcus aureus, making it a treatment option in the management of chronic wounds in which the bacterium plays a role. We’re hoping it will serve the same function in the sinuses.”
Faculty mentors for the residents are Luong; Dr. Martin Citardi, professor and chair of the department; and Dr. Samer Fakhri, associate professor and residency program director.
Researchers find heart muscle ‘sells the family silver’
UTHealth researchers have discovered that heart muscle cells eat their own proteins in order to stay alive.
The original research paper by Kedryn Baskin, a student in the Program of Integrative and Regulatory Biology of the Graduate School of Biomedical Sciences, and Dr. Heinrich Taegtmeyer, professor of medicine in the Division of Cardiovascular Medicine, was recently published in Circulation Research, a publication of the American Heart Association.
In animal models, the investigators found that a stressed heart activates a signal, which takes down unneeded proteins. This process, in turn, makes it possible for the cell to survive and rebuild itself.
“We believe we are beginning to understand a whole new chapter in the biology of the heart—self-renewal of the cardiomyocytes. It’s like the heart muscle selling its family silver to stay alive,” Taegtmeyer said.
His lab is now working on other mechanisms by which the heart takes down old and useless proteins and replaces them with new and functional ones. If successful, the work will lead to new ways to treat heart failure, a disease that claims the lives of 500,000 Americans each year.
A fair to remember
More than 30 vendors participated in the 25th Annual Holiday Arts and Craft Fair Dec. 1 in the Medical School's Leather Lounge. This annual event is sponsored by the Employee Relations Committee.
— Dwight C. Andrews, Office of Communications, Medical School
Events to know
Orthopaedic Grand Rounds: Dr. Johnny Huard (University of Pittsburgh) presents, “Muscle Healing after Injury.”
7–8 a.m., MSB 2.103., videoconferenced to LBJ Annex Auditorium, Room 217.
Department of Integrative Biology and Pharmacology Seminar Series: Dr. Eran Andrechek (Michigan State University) presents, “Modeling Breast Cancer in the Mouse: Genetic Tests of Genomic Predictions.”
4–5 p.m., MSB 2.103.
Department of Biochemistry & Molecular Biology Seminar Series: Dr. Anil K. Sood (MD Anderson Cancer Center) presents, “Neuroendocrine Influences on Tumor Microenvironment.”
11:45 a.m.–12:45 p.m., MSB 2.135.
Department of Integrative Biology and Pharmacology Seminar Series: Dr. Xinzhong Dong (Johns Hopkins) presents, “Molecular and genetic analysis of pain and itch sensation.”
4–5 p.m., MSB 2.135.
Good Clinical Practices: Dr. Milton Marshall, IMM, and Dr. Nicole Gonzales, assistant professor of neurology, present, “IND/IDE Regulations.”
11:45 a.m.–1 p.m., MSB 2.135.
Lunch will be available for the first 25 attendees. Registration is not required.
Department of Psychiatry & Behavioral Sciences Grand Rounds: Dr. Alan Swann, professor of psychiatry, presents, “Practical Neurobiology of Bipolar Disorder.”
Noon–1 p.m., HCPC Auditorium.
Family & Community Medicine Grand Rounds: Dr. Erwin Boco, PGY III in the Department of Family and Community Medicine, presents, “Case Presentation.”
1–2 p.m., MSB 2.135.
Department of Neurosurgery Grand Rounds: Drs. Carin Hagberg and Carlos Artime, Department of Anesthesiology, present, “Conscious Sedation.”
8–9 a.m., MSB G.100.
Microbiology and Molecular Genetics Seminar Series: Dr. Matthew Lawrenz (University of St. Louis School of Medicine) presents, “Stick with me: Post-translational regulation of a Yersinia pestis adhesion.”
10:45 a.m., MSB 2.135.
Department of Integrative Biology and Pharmacology Seminar Series: Dr. Fred Pereira (Baylor) presents, “Tuning Cholesterol for Hearing Sensitivity.”
4–5 p.m., MSB 2.135.
Medical School full closure holiday.
Medical School skeleton crew holidays.
New Year holiday.
Medical School full closure holiday.
Microbiology and Molecular Genetics Seminar Series: Faculty candidate Dr. Shonna McBride (Tufts University School of Medicine) presents, “The C. difficile cpr locus mediates resistance to antimicrobial peptides through molecular mimicry.”
10:45 a.m., MSB 2.135.
Dr. Martin Citardi, professor and chair of the Department of Otorhinolaryngology-Head and Neck Surgery, and Dr. Samer Fakhri, associate professor of otorhinolaryngology, have been named to the 2011 Best Doctors in America® list, which includes the nation’s most respected specialists and outstanding primary care physicians. The list represents the top 5 percent of doctors in the United States selected from among more than 46,000 physicians in over 400 specialties and subspecialties.
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