New method may save more lives in older heart attack patients

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Recent research has sparked a potential change in how heart attacks are treated in elderly patients, suggesting that clearing all major arteries, not just the one directly responsible for the heart attack, could significantly improve outcomes.

Traditionally, doctors have concentrated on opening only the “guilty” artery due to concerns about complications, especially in older patients who typically have multiple health conditions.

Dr. Simone Biscaglia, an interventional cardiologist at Ferrara University Hospital in Italy and the lead researcher of the study, emphasized that the findings challenge previous assumptions.

“What we found is the exact opposite of what we used to think,” he remarked, advocating that treating all significantly blocked arteries should become the new standard of care for older patients.

The study involved 1,445 patients, half of whom were over 80 years old. These patients were either treated for just the main artery causing the heart attack or had all major blocked arteries opened.

The results indicated a remarkable improvement in safety and outcomes for those who received more comprehensive treatment. Specifically, the risk of dying or having another heart attack within a year was reduced by 36% for patients who had all their blocked arteries treated.

Furthermore, when considering all measured outcomes—including death, subsequent heart attacks, or the need for additional procedures—the risk was reduced by 27%.

Dr. Gregg Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center in Los Angeles, supported these findings, stating, “The complete revascularization strategy in heart attack is superior to a culprit lesion-only approach in patients age 75 or older.”

He noted that while previous research mostly included younger patients, this study confirms that older patients also benefit significantly from this approach.

The implications for medical practice are considerable, as echoed by Dr. Gaurav Rao, an interventional cardiologist at Northwell Atlas Bass Heart Hospital in Manhasset, N.Y.

He suggested that the study’s practical implications are clear: “Older patients are going to benefit from complete revascularization rather than fixing only the culprit vessel, and they are going to do better in the long run.”

Given these promising results, experts are advocating for a shift in the standard of care to include complete revascularization for all heart attack patients, regardless of age, who have multiple blocked arteries.

This approach could potentially lead to better long-term health outcomes and fewer complications for elderly patients suffering from heart attacks.

The study’s findings, which were published online in the New England Journal of Medicine and presented at the European Society of Cardiology meeting in Amsterdam, add substantial weight to the growing consensus on the benefits of comprehensive artery clearing in the treatment of heart attacks.

This research marks a significant step forward in cardiac care, particularly for the aging population, and may lead to widespread changes in treatment protocols across the globe.

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