For many years, doctors have usually focused on treating only the blocked artery that directly caused a heart attack.
This artery is often called the “culprit” or “guilty” artery because it is responsible for cutting off blood flow to part of the heart muscle.
Once blood flow is restored, doctors often leave other narrowed or blocked arteries alone, especially in older patients.
This careful approach has been based on the belief that extra procedures might place elderly people at greater risk because they are more likely to have other medical conditions, frailty, or slower recovery.
However, a new international study is challenging this long-held belief. Researchers have found that older adults may actually have better outcomes if doctors treat all of the major blocked heart arteries instead of only the one that caused the heart attack.
The findings suggest that a more complete treatment approach could save lives and reduce the risk of future heart problems.
The study was led by Dr. Simone Biscaglia from Ferrara University Hospital in Italy. According to Dr. Biscaglia, the results were the opposite of what many doctors had expected. Instead of increasing risk, opening all major blocked arteries appeared to improve survival and reduce serious complications, even in people over the age of 80.
Heart attacks usually happen when a fatty deposit inside a heart artery suddenly breaks open and forms a blood clot. The clot blocks blood flow, preventing oxygen from reaching part of the heart muscle.
Without quick treatment, heart muscle begins to die. Doctors usually reopen the blocked artery using a procedure called angioplasty, in which a small balloon is used to widen the artery and a tiny metal tube called a stent is often placed inside to keep it open.
Many people who suffer a heart attack have more than one narrowed artery. Until recently, doctors often chose not to treat the additional blockages during the same period of care, particularly in older adults. They worried that longer procedures might increase complications.
To test whether this traditional approach was still the best choice, the researchers studied 1,445 people who had suffered a heart attack and had blockages in more than one major heart artery. About half of the participants were older than 80 years of age.
Some patients received treatment only for the artery responsible for the heart attack, while others underwent complete revascularization, meaning all major blocked arteries were opened.
The results were clear and encouraging. Patients who received complete treatment had a 36% lower risk of dying or suffering another heart attack during the following year. When researchers looked at a combined measure that included death, another heart attack, or the need for another procedure to restore blood flow, the overall risk was reduced by 27%.
These findings suggest that treating all important blockages may help improve blood flow throughout the heart, lower the chance of future artery blockages causing new heart attacks, and reduce the need for additional hospital visits and procedures.
Heart experts who were not involved in the research also welcomed the findings. Dr. Gregg Fonarow, a cardiologist at UCLA, noted that earlier studies mainly involved younger patients.
This new research provides strong evidence that older adults can also benefit from complete artery treatment. Dr. Gaurav Rao, a cardiologist in New York, agreed that elderly patients are likely to have better long-term outcomes when all major blocked arteries are treated instead of only the artery that caused the heart attack.
Although the results are very promising, doctors will still need to consider each patient’s overall health before deciding on the best treatment plan.
Factors such as kidney disease, severe frailty, or other serious illnesses may still influence whether a longer procedure is appropriate. Even so, the study suggests that age alone should not prevent older adults from receiving complete artery treatment.
The researchers believe these findings could lead to important changes in international medical guidelines. If adopted, more older heart attack patients around the world may receive complete treatment for all major blocked arteries, giving them a better chance of living longer and avoiding future heart problems.
The research was published in the New England Journal of Medicine and was also presented at the European Society of Cardiology meeting in Amsterdam.
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