A large study has found that heart attack victims are less likely to die in hospitals where angioplasty is the usual emergency treatment rather than clot-destroying drugs.

Examining the records of 463 hospitals, researchers found that the group of hospitals that performed angioplasty the most often had a 36 percent lower risk of in-hospital death compared with the group of hospitals that used it least.

But not all hospitals can provide rapid access to angioplasty because they lack either the equipment or the staff to operate it 24 hours a day.

Dr. Harlan M. Krumholz, the senior author on the report and a professor of medicine at Yale, said he believed that inserting the catheter for angioplasty was the best treatment. The paper appeared in the journal Circulation on Jan. 17.

Dr. Krumholz said that if he lived 10 minutes from a hospital that provided angioplasty and 10 minutes from one that provided only the drug treatment, he would "choose the one that did the invasive procedure every time." Still, Dr. Krumholz emphasized that practical limits must be considered.

"If a hospital can provide both, it seems advantageous to commit to primary percutaneous coronary intervention," he said, referring to angioplasty.

"But if a hospital can't do that, they need to develop systems that minimize the time delays in deciding between the two therapies," he continued. "All things being equal, you're better off at a hospital that has committed to one or the other."