In heart attack patients, treating only the coronary artery that caused the infarction is as effective as prophylactic balloon dilation of other coronary arteries, according to a new large-scale study by researchers at the Karolinska Institutet and others. . Result is, New England Medical Journal.

Heart attack is a common illness that carries the risk of serious complications. It has long been unclear what the best strategy is to treat coronary artery stenosis independently of the specific vessel that caused the infarction.

A new large-scale study conducted in Sweden suggests whether it is enough to treat just the coronary artery that caused the infarction, or whether treating other narrowed blood vessels with balloon dilation as a preventive measure may be better in the long term. We investigated whether the results were good.

This clinical randomized study involved 1542 patients from 32 hospitals in seven countries. In the Swedish part, randomization was performed and data were collected using the SWEDEHEART registry. Patients were followed for 5 years after surgery.

There were no differences between the groups in the total number of new heart attacks, new unplanned balloon dilations, or all-cause deaths.

“This is a bit surprising. Our hypothesis was that it would be beneficial to perform prophylactic angioplasty,” said the senior doctor at the Department of Clinical Sciences at Karolinska Institutet Danderyd Hospital, who led the study. Felix Boehm says:

However, when it comes to the problem of angina pectoris, studies have shown that preventive treatment can prevent patients from returning for balloon dilatation. According to Felix Boehm, this suggests that we should still aim for complete treatment of all blood vessels.

“But for patients who have something that complicates complete revascularization, they may choose to wait. There was no difference in the most serious complications, new heart attacks or deaths.” “, says Felix Böhm.

Felix Boehm says these patients can later return for new treatment if angina problems occur.

“The positive finding of this study was that regardless of the treatment strategy chosen, most patients do not relapse with new problems. Currently, heart attack patients are well treated with drugs, so It is difficult to find other interventions that have an even more important effect on “risk reduction,” says Felix Boehm.

The researchers will now investigate how patients’ angina and other quality of life parameters are affected by different treatment strategies, as well as the health economic aspects of the chosen strategies.

The study was conducted by Uppsala Clinical Research Center (UCR) at Uppala University. The legal sponsor was Karolinska University Hospital. This research was funded by the Swedish Research Council, Hjart Lunfonden, Stockholm Region, Abbott, and Boston Scientific. Neither company had any influence on the study design, analysis of results, or writing of the paper.

Publication: “FFR-guided full or culprit-only PCI in patients with myocardial infarction”, Felix Böhm, Brynjölfur Mogensen, Thomas Engstrom, Goran Stankovic, Ilija Srdnaovic, Jacob Lønborg, Sammy Zwackman, Mehmet Hamid, Thomas Kellerth, Jörg Lauermann, Olli A Kajander , Jonas Andersson, Rikard Linder, Oskar Angerås, Henrik Renlund, Andrejs Ērglis, Madhav Menon, Carl Schultz, Mika Laine, Claes Held, Andreas Rück, Ollie Östlund, Stefan James, New England Journal of Medicine, online April 8, 2024 , doi: 10.1056/NEJMoa2314149