A new large study conducted by researchers at Karolinska Institutet and others has found that treating only the coronary artery that caused a heart attack is just as effective as preventive balloon dilation of other coronary arteries. The study, published in the New England Journal of Medicine, aimed to determine the best strategy for treating narrowings in coronary arteries separate from the vessel that caused the infarction. Heart attack is a common disease with risks of serious complications, and it has long been unclear how best to approach treatment in these cases.
The clinical randomized study included 1542 patients from 32 hospitals in 7 countries, with the Swedish part of the study using the SWEDEHEART registry for randomization and data collection. Patients were followed up for five years after the procedure. The results showed no significant difference between the groups in terms of new heart attacks, new unplanned balloon dilations, or total all-cause deaths. The findings were somewhat surprising, as the researchers had hypothesized that preventative angioplasty would be beneficial in these cases.
Despite the lack of difference in major complications such as new heart attacks and deaths, the study showed that preventive treatment could help avoid patients needing new balloon dilations due to problems with angina. This suggests that complete treatment of all vessels may still be beneficial in some cases, although it is not necessary for all patients. Patients who experience angina symptoms can still return for a new treatment if needed, as there was no significant difference in outcomes between the treatment strategies.
The researchers also noted that most patients did not experience new problems regardless of the treatment strategy chosen. With the advancements in drug treatment for heart attack patients, it has become challenging to find additional interventions that provide significant risk reduction. The study’s positive finding was that the majority of patients did not require further treatments, indicating that current drug treatments are effective in managing the condition and preventing complications.
Future research will focus on how treatment strategies impact angina and other quality of life parameters in heart attack patients. Additionally, the study will explore the health economic aspects of the chosen treatment strategies to understand the long-term implications of different approaches. The study was conducted by Uppsala Clinical Research Center at Uppsala University, with Karolinska University Hospital as the legal sponsor. Funding for the study was provided by the Swedish Research Council, Hjärt-Lungfonden, Region Stockholm, Abbott, and Boston Scientific, with no influence on study design or results analysis by the funding companies.
