Older people who suffer a heart attack may do better when doctors treat more than the single artery that triggered the emergency, according to a major clinical trial.
The study found that addressing other severely narrowed heart arteries lowered the risk of additional heart problems over the next year.
Called the FIRE trial, the research included 1,445 participants aged 75 and older and appeared in the New England Journal of Medicine in 2023.
A heart attack occurs when blood flow to part of the heart is blocked. Without enough oxygen and blood, the heart muscle can be damaged.
Doctors commonly use a thin tube and a small balloon to open the blocked artery, and they may also place a stent, a tiny mesh tube that helps keep the artery open.
Some patients, however, have several narrowed arteries. In those cases, doctors must decide whether to treat only the artery linked to the heart attack or also open other significant blockages.
This can be a tough choice for older patients, since extra procedures may bring added risk.
Researchers led by Simone Biscaglia at University Hospital of Ferrara in Italy compared two treatment strategies.
All participants were treated for the artery responsible for the heart attack. In one group, doctors also treated other arteries when tests showed that the narrowings were severely restricting blood flow.
The average participant was about 80 years old.
After one year, 15.7% of those who received the more complete treatment had died, had another heart attack or stroke, or required another artery-opening procedure.
In the group treated only for the artery tied to the heart attack, that rate was 21%.
In other words, the more complete approach led to about five fewer cases per 100 people of these problems.
Researchers also examined death from heart-related causes or a repeat heart attack. Those events occurred in 8.9% of the more-complete-treatment group, compared with 13.5% in the other group.
The study did not show a clear difference between the groups in a combined measure of certain complications, including bleeding, stroke, and kidney injury.
That does not mean extra procedures are without risk. Doctors still need to weigh a patient’s overall health and decide which arteries should be treated.
The results suggest that age alone should not exclude older adults from being considered for more complete treatment after a heart attack.
For carefully chosen patients, opening additional severely narrowed arteries may offer meaningful protection.
Source: University Hospital of Ferrara.
Credit: Unsplash+
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