A major international study has found that opening all blocked arteries during a heart attack—not just the one causing the immediate problem—can greatly improve survival and prevent future heart attacks.
The research, led by scientists at the Population Health Research Institute (PHRI), a partnership between McMaster University and Hamilton Health Sciences in Canada, provides strong evidence that this approach, known as complete revascularization, can save lives.
The findings were presented at the 2025 American Heart Association Scientific Sessions in New Orleans and published in the medical journal The Lancet.
When someone has a heart attack, doctors typically rush to open the blocked artery that caused it. However, many patients also have other narrowed or blocked arteries that are not immediately treated.
This raises an important question for cardiologists: should they fix only the artery causing the heart attack or open all the blockages found during the procedure?
Until now, the answer has not been completely clear. Previous smaller studies showed that opening all blocked arteries could reduce the risk of future heart problems, but it was not certain whether it also helped patients live longer.
Dr. Shamir R. Mehta, a senior scientist at PHRI and the study’s lead author, explained that by combining data from several large clinical trials, researchers were finally able to answer that question. They looked at results from six international trials involving 8,836 patients who had suffered a heart attack.
The average age of participants was about 66 years, and about one in four were women. The patients were followed for three years to compare outcomes between those who received complete revascularization—meaning all blocked arteries were opened with stents—and those who had only the main blocked artery treated.
The results were striking. Patients who received complete revascularization had a one-quarter lower risk of dying from heart-related causes or having another heart attack compared with those treated for only one artery.
Specifically, 9% of patients who received complete treatment experienced cardiovascular death or a new heart attack, compared with 11.5% of those who only had the main blockage opened. Deaths from heart-related causes were 3.6% versus 4.6%, representing a 24% reduction.
Deaths from any cause were also lower—7.2% compared with 8.1%—a 15% decrease. Importantly, deaths unrelated to heart disease, such as from cancer or infection, were about the same in both groups, showing that the benefit came specifically from heart-related improvements.
These positive effects were seen across different types of heart attacks. Patients with both STEMI (the most severe type of heart attack caused by a complete blockage) and NSTEMI (a less severe type caused by partial blockage) benefited from opening all blocked arteries.
The benefits were also seen across age groups, in both younger and older patients. All patients in the study also received modern treatments such as blood thinners, statins, and blood pressure medications, meaning the advantages of complete revascularization came in addition to standard care.
Dr. Mehta said the study’s results are a turning point in how heart attacks are treated. “By reducing premature death, this large international study takes the importance of complete revascularization to a different level,” he explained.
“It firmly establishes this approach as one of the few life-saving procedures available to cardiologists that not only prevents future heart attacks but also extends life. That’s a major advance with global implications.”
From a medical perspective, the study settles a long-running debate among heart specialists. Until now, some doctors preferred to only treat the main artery during a heart attack, fearing that treating additional arteries could increase risks during the procedure.
However, this new analysis, combining data from over 8,000 patients worldwide, clearly shows that treating all blockages provides a major survival benefit without increasing non-cardiac risks.
Reviewing the study findings, experts say that this research could change standard practice in hospitals worldwide. The evidence now supports complete revascularization as the best strategy for most patients experiencing a heart attack with multiple blocked arteries.
It offers a more comprehensive solution that not only prevents future heart attacks but also prolongs life. This study highlights how advances in interventional cardiology continue to save lives and improve recovery for heart attack patients around the world.
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The study is published in The Lancet.
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