Published Mar 20, 2026 | 7:05 AM ⚊ Updated Mar 20, 2026 | 7:05 AM
A heart attack is caused by total or near total blockage of one or more of the three coronary arteries. (Creative Commons)
Synopsis: A Chennai-based study shows delayed angioplasty after a heart attack can still save lives, but delays in seeking care, poor access, costs and limited facilities continue to hinder timely, effective treatment outcomes.
A few hours can decide life or death in a heart attack — but what if patients miss that window? A recent Chennai-based study suggests there may still be a second chance, even as deeper gaps in access continue to cost lives.
A study from Madras Medical College, based on data from the Institute of Cardiology and Rajiv Gandhi Government General Hospital, has found that performing angioplasty — a procedure to open blocked heart arteries — up to 48 hours after initial clot-busting treatment can yield outcomes similar to immediate intervention.
“If we cannot do angioplasty within 24 hours, doing it between 24 and 48 hours also seems to be good enough in selected cases,” Dr Justin Paul Gnanaraj, professor of cardiology and lead author of the study, Tamil Nadu nodal officer for heart disease, told South First.
Doctors said the biggest hurdle is not treatment delay, but delay at the patient level.
“Many patients think it is gastritis or something minor, and delay going to the hospital,” Dr Gnanaraj said. “The first delay is deciding to seek medical help — that is very common.”
Even after deciding, practical barriers slow things further. “People delay due to family responsibilities or waiting for someone to accompany them,” he added.
Access to the right facility is another challenge. “Patients often go to a hospital that does not have the facility for definitive treatment, and then get referred, losing time,” he said.
Published in the American Journal of Cardiology, the study analysed 2,499 patients with ST-elevation myocardial infarction — a severe form of heart attack caused by a blocked artery — using registry data from Madras Medical College.
It compared patients who underwent immediate angioplasty or primary PCI, a procedure to open blocked arteries, with those who first received clot-busting treatment and later underwent angioplasty within an extended window of 3–48 hours.
Of the total patients, 248 underwent immediate angioplasty, while 210 received delayed angioplasty after clot-busting treatment. A large proportion — 1,091 patients (43.7%) — received only clot-busting drugs, 825 (33%) did not undergo any procedure to restore blood flow, and 125 had delayed angioplasty.
PCI up to 48 hours after fibrinolysis yielded outcomes comparable to primary PCI, it noted.
The study found similar complication rates, in-hospital deaths and one-year mortality in both early and delayed groups, and added that “PCI at any time during hospitalisation was independently associated with improved survival.”
In conclusion, the study suggests that extending the angioplasty window up to 48 hours after initial treatment can be a safe and practical approach in real-world settings, especially where immediate access to advanced cardiac care is limited.
Current guidelines recommend angioplasty within 24 hours after clot-busting therapy. This study suggests that, in real-world settings, that window can be extended.
“What we looked at was — if immediate angioplasty is not possible, can we safely extend the window. Our findings suggest we can push it up to 48 hours,” Gnanaraj said.
However, he cautioned that early treatment remains critical. “Clot-busting drugs work best within 6 hours, and up to 12 hours in some cases. Beyond that, the risks may outweigh the benefits,” he explained.
Similarly, angioplasty is most effective before heart muscle damage becomes irreversible. “Beyond a certain point, much of the heart muscle may already be damaged, and the benefit of putting a stent becomes limited,” he said.
The findings shift focus from just timing to a larger issue — access to care.
Dr Gnanaraj emphasised that the issue goes beyond just poverty. “It is not just poverty — we look at it as access to care, which includes awareness, affordability, availability and trust,” he said.
Cost remains a major barrier. “Hospitals may offer the best treatment as per guidelines, but not always what suits the patient’s affordability,” he noted. “Treatment is not always customised to the patient’s financial situation, and that can lead to delays.”
Insurance processes can further slow care. “Insurance approvals, with multiple queries and clarifications, can delay treatment,” he added.
Trust is another factor. “Some patients do not trust the first doctor’s advice and go for second opinions, losing valuable time,” he said.
While the study opens up a “second window” for treatment, doctors stress it should not dilute the urgency of early care. Instead, it highlights the need for more practical, patient-centred pathways in real-world settings.
Gnanaraj pointed out that treatment is often not aligned with what patients can afford. In some cases, an expensive angioplasty is offered upfront, when a lower-cost clot-busting drug could stabilise the patient and allow timely referral.
“The system does not look at the patient’s affordability and modify the treatment options,” he said.
He recalled a patient who waited nearly four hours after diagnosis before proceeding with treatment. “The earlier we treat, the better the outcomes.
But even when there is a delay, we should not give up on offering treatment,” he said, underscoring that access — across cost, decision-making and care pathways — remains critical.
(Edited by Muhammed Fazil.)
