Best way to open arteries during heart attack in old age

Best way to open arteries during heart attack in old age

Improved Outcomes for Elderly Patients: Clearing All Heart Vessels After a Heart Attack

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After a heart attack, elderly adults have better odds for improved health and survival if all major heart vessels are cleared, not just the one that caused the heart attack. While doctors often focus on opening the “culprit” blood vessel and leave other partially blocked vessels alone due to concerns about complications, recent research suggests a shift in this approach. Clearing all these vessels lowers the one-year risk for death, having another heart attack or stroke, or needing another procedure.

“This could be a real change in practice because the actual standard of care in most older patients is just to treat the culprit lesion, because physicians are worried about complications. Basically, the idea was that the prognosis was worse if we do more,” said lead researcher Dr. Simone Biscaglia, an interventional cardiologist at Ferrara University Hospital in Italy. “What we found in the study is the exact opposite. Complete revascularization should be pursued in older patients with heart attack and multi-vessel disease.”

The Importance of Complete Revascularization

Clearing all the arteries that are significantly blocked should become the standard of care regardless of a patient’s age. According to Dr. Gregg Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center in Los Angeles, recent clinical trials have established the superiority of complete revascularization for patients with a heart attack. Most of these trials have focused on younger patients, overlooking the unique needs of the elderly population. However, the findings from this trial involving 1,445 men and women aged 75 and older confirmed the benefits for this age group as well.

For the study, patients were randomly assigned to have only the culprit heart artery unblocked or all the major blocked arteries opened. The results were significant: among patients who had all their narrowed heart arteries opened, the one-year risk of death or another heart attack was reduced by 36% compared to patients who only had one artery opened. Additionally, the risk of death, another heart attack or stroke, or needing another procedure was reduced by 27% in the complete revascularization group.

Safety and Positive Long-Term Outcomes

Contrary to concerns about the safety of complete revascularization in elderly patients, the researchers noted that the procedure was equally safe in both groups. This suggests that after a heart attack, older patients are likely to benefit from complete revascularization rather than only addressing the culprit vessel. Ultimately, this approach leads to better long-term outcomes.

Dr. Gaurav Rao, an interventional cardiologist at Northwell Atlas Bass Heart Hospital in Manhasset, N.Y., emphasizes that this study adds more credibility to a practice that has already been applied to younger patients. It effectively changes the way healthcare professionals deal with patients over 75 years of age following a heart attack. By opting for complete revascularization, these older patients have a greater chance of improved health and survival.

The report detailing these findings was published online on August 26 in the New England Journal of Medicine and presented simultaneously at the European Society of Cardiology meeting in Amsterdam.

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Conclusion

The treatment of elderly patients after a heart attack is evolving, with new evidence indicating that clearing all significant coronary blockages is superior to focusing solely on the culprit artery. This recent study reinforces the importance of complete revascularization for patients aged 75 and older, debunking the previous notion that a less aggressive approach was preferable due to concerns about complications. Moving forward, healthcare providers need to adopt this holistic approach to ensure the best possible outcomes for elderly patients recovering from a heart attack.