When a patient arrives at the hospital with severe chest pain, doctors perform an electrocardiogram (ECG) to quickly detect a major heart attack.
If one is identified, the patient is usually rushed to the catheterisation lab where angioplasty and stenting are performed to reopen the blocked coronary artery – a procedure known as percutaneous coronary intervention (PCI).
A balloon is used to widen the blocked artery, and a stent is inserted to keep it open.
This procedure saves lives by restoring blood flow to the heart, limiting heart muscle damage, and reducing immediate complications.
However, emerging evidence suggests that reopening the main artery alone may not be enough.
ZOLL Medical Corporation clinical evidence manager Dr Sivah Sandrasakre explains that while stenting addresses the major coronary arteries, these vessels supply only about 10% of the heart muscle.
“The remaining 90% is supplied by the microvascular circulation,” he says.
This intricate network of tiny blood vessels, including capillaries, delivers oxygen and nutrients directly to the heart tissue.
But problems within these smaller vessels cannot be detected during PCI.
In some patients, even after the main artery is successfully re- opened, the microcirculation remains obstructed – a condition known as microvascular obstruction.
This restricts oxygen delivery and can lead to ongoing heart muscle damage.
“If the microvascular system is not adequately restored after a heart attack, the heart muscle continues to suffer,” Dr Sivah explains.
“That increases the risk of long-term complications.”
In order to address this issue, supersaturated oxygen therapy (SSO₂) is provided.
SSO₂ is administered in the cardiac catheterisation laboratory immediately after angioplasty.
The therapy works by significantly increasing the amount of oxygen dissolved in the blood.
Highly-oxygenated saline is mixed with the patient’s own blood to create supersaturated blood containing seven to 10 times more dissolved oxygen than usual.
This oxygen-rich blood is then infused directly into the coronary circulation through a small catheter over 60 minutes.
Because the oxygen is delivered in dissolved form, it can reach areas with impaired blood flow, helping to restore oxygen delivery at the microvascular level.
Consultant cardiologist Dr Shathiskumar Govindaraju notes that: “By delivering high concentrations of oxygen to the microcirculation, supersaturated oxygen therapy helps reduce oedema, reduce cardiac muscle injury, improve oxygenation and promote healing of the heart muscle, potentially lowering the risk of heart failure.
“Traditional treatments focus on reopening the major vessels, but do not address the microvasculature, which cannot be treated with conventional stenting.
“Supersaturated oxygen therapy is currently the only treatment designed to target both the major arteries and the microvascular circulation.”
Early intervention, he adds, may improve long-term outcomes and reduce the financial burden associated with chronic heart failure.
He points out that heart attack survivors in Malaysia face two major risks: sudden cardiac death within the first year and the development of heart failure.
“The risk of sudden death increases due to recurrent heart attacks,” he explains.
“If patients survive the initial event, the longer-term challenge is damage to the heart muscle, which can lead to heart failure.”
Heart failure develops in around one in five patients after a heart attack and remains costly to manage.
The combined cost of angioplasty and SSO₂ therapy ranges from RM100,000 to RM120,000, including hospital admission, medications and related expenses.
While the upfront cost is considerable, insurance providers are increasingly beginning to include the treatment in their coverage plans, gradually improving access.
By comparison, managing heart failure can impose an even heavier financial burden on patients and their families.
“The cost of treating heart failure is substantial, particularly for younger patients,” says Dr Shathiskumar.
“Some face annual expenses exceeding RM200,000.”
Currently, SSO₂ therapy is available in Hospital Sultan Idris Shah in Serdang, and a private hospital in Klang – both in Selangor.
