Q. My dad is an overweight couch potato. He had chest pressure last week — it was a heart attack. His doctor said it was good he went to the emergency room immediately, because the sooner they could put a stent into his heart, the sooner blood through a blocked vessel could flow again, so less heart muscle died. But aren't drugs such as clot-busters just as good? My dad had balloon angioplasty, where a small balloon inserted by a catheter through the groin was guided to the blocked blood vessel and then inflated to crush the clot or plaque into the walls of the artery.

A. Yes — and after the balloon opens up the artery, a stent looking like a chicken-wire tunnel was left inside to prop open the vessel.

Intravenous clot-busting drugs like tPA also work, and the sooner, the better, with a 47 percent reduction in death if given within the first hour of chest pain.

But angioplasty works better and faster, though not all hospitals can do emergency angioplasties. In a meta-analysis of six studies involving 3,750 heart-attack victims, transferring a patient by ambulance from one hospital to another that could do angioplasties resulted in a 42 percent reduction in death, second heart attack, or stroke compared with getting clot-busting drugs at the first hospital, despite a delay of about 1 to 2 hours to get the angioplasty. For instance, folks getting angioplasties have fewer strokes and less bleeding inside the brain than those getting clot-busting drugs. And clot-busting drugs work only 33 percent to 60 percent of the time to dissolve clots within 90 minutes. So for heart attacks where there is complete blockage — those with so-called ST elevations on the electrocardiograph — angioplasty is preferred over clot-busting drugs, as long as the hospital is experienced at doing them. By 12 hours, it's generally too late for clot busters or angioplasty.

Half of heart-attack victims die before reaching the E.R. A heart attack may feel more like a chest pressure or tightness than an actual pain, often with sweating, nausea or discomfort in the arm or jaw, or only sudden shortness of breath. Call 911, even if you're not sure — even minutes count. If there's no aspirin allergy or active bleeding, the paramedics may have you chew two baby aspirins or half of an adult aspirin before driving to the E.R.

So if you're a couch potato, start exercising, and if you're overweight, lose weight and get your blood sugars and cholesterols (both the good and bad subfractions) checked to make sure you don't get clogged arteries in the first place.

Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine. Send your questions to Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; or write islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.