Preventive Angioplasty: Safe for Most STEMI Patients

Preventive angioplasty may be the next big thing. In a study presented at the American College of Cardiology meeting in San Diego, CA, researchers recommended complete revascularization of constricted arteries in patients who had a STEMI heart attack.

Thomas Engstrom, MD, PhD, senior consultant at the University of Copenhagen and colleagues looked at 627 STEMI patients in Denmark who were randomized to receive either standard care or complete revascularization after surviving a heart attack.

After 27 months, 17% of patients who got standard care were back for unplanned angioplasty or bypass surgery, vs. only 5 % of patients who got revascularization right after their heart attack.

Rates of heart attacks and death were comparable in the 2 groups.

“Our results show that it is safe to do a complete revascularization in this particular patient population, Engstrom said.

He said he favored changing guidelines to reflect his findings. “It may help patients avoid returning for future angioplasty in an urgent manner.”

The ACC in Sept. 2014 changed its angioplasty guidelines for treating patients getting PCI to remove arterial lesions that led to heart attacks. Instead of just removing the lesion in the culprit artery, physicians should remove lesions in both cardiac arteries, the ACC decided.

The change was based on results of a study known as CvLPRIT, for Complete Versus Lesion only Primary-PCI trial.”

That UK study showed such patients had a 55% rduction in major adverse cardiac events when they had both arteries treated.

According to the ACC, about 250,000 Americans experience a STEMI heart attack annually, and about 40% have narrowing in other coronary arteries, that is, multi-vessel disease.

Engstrom’s study called for doing the second angioplasty 2 days after the attack, but he said he favors more research to look at whether it could be done even sooner.