For heart attack patients, treating only the coronary artery that caused the heart attack works as well as preventive balloon dilation of the other coronary arteries, according to a large new study by researchers at the Karolinska Institutet and others. The results are published in the New England Journal of Medicine.
Heart attack is a common illness with risks of serious complications. The best strategy for treating narrowings in coronary arteries separate from the specific vessel that caused the heart attack has long been unclear.
A new large Swedish study has investigated whether it is sufficient to treat only the coronary artery that caused the heart attack, or whether long-term results are better if other narrowed vessels are also treated with balloon dilation as a preventive measure.
The randomized clinical study included 1,542 patients from 32 hospitals in 7 countries. In the Swedish part, the SWEDEHEART registry was used to perform randomization and collect data. Patients were followed for five years after the procedure.
The results show no differences between the groups in terms of new heart attacks, new unplanned balloon dilations or the total number of deaths from all causes.
“This is somewhat surprising. Our hypothesis was that it would be beneficial to perform preventive angioplasty,” says Felix Böhm, senior physician at the Department of Clinical Sciences at Danderyd Hospital of the Karolinska Institutet, who led the study.
However, when it comes to angina problems, the study shows that it is possible to prevent patients from returning for further balloon dilations through preventative treatment. According to Felix Böhm, this suggests that we should still aim for a complete treatment of all vessels.
“But for those patients in whom there is some circumstance that complicates complete revascularization, one could choose to wait, since there was no difference in the most serious complications: new heart attack and death,” says Felix Böhm.
According to Felix Böhm, if angina problems occur, these patients can return later for new treatment.
“A positive finding of the study was that most patients do not return with new problems, regardless of the treatment strategy chosen. “Today, heart attack patients are treated so well with medications that it is difficult to find other interventions that provide more significant benefits. risk reduction,” says Felix Böhm.
The investigators will now continue to investigate how different treatment strategies affected patients’ angina and other quality of life parameters, as well as the health economic aspects of the chosen strategy.
The research was carried out by the Uppsala Clinical Research Center (UCR) of Uppala University. The legal sponsor was Karolinska University Hospital. The study was funded by the Swedish Research Council, Hjärt-Lungfonden, Stockholm Region, Abbott and Boston Scientific. The companies had no influence on the study design, analysis of results, or writing of articles.