With older heart attack patients often less likely to be offered these procedures, the Newcastle University findings reveal important insights into potential benefits of surgery, that could help clinicians better tailor treatment plans to individuals.

While invasive treatment also reduced the need for future surgeries, it did not reduce the risk of heart-related deaths when compared to a non-invasive approach.

The new research, published in the New England Journal of Medicine, was also presented at the European Society of Cardiology Congress 2024 by Professor Vijay Kunadian.

Invasive coronary angiogram

Professor Kunadian, Chief Investigator at Newcastle University, said: “Older heart attack patients are less likely to receive a treatment such as angiograms, however, our study has demonstrated that it is safe and for some may be a suitable option.”

There are around 50,000 hospital admissions every year in the UK due to suspected NSTEMI heart attacks – where the coronary arteries that supply the heart with blood are severely narrowed but not completely blocked.

Currently, guidelines recommend that patients who are considered at risk of further events have an invasive coronary angiogram within 72 hours.

An invasive coronary angiogram involves inserting a small tube (called a catheter) into an artery and guiding it up to the heart. This allows doctors to look inside a patient's coronary arteries to check for narrowing or blockages and plan treatment.

While common and straightforward, the procedure has around a one per cent risk of complications including bleeding and strokes, and older adults are offered this less frequently.

In the largest and longest study of its kind, the team tested treatment approaches in more than 1,500 patients aged 75 or older who had had an NSTEMI heart attack.

Researchers compared a non-invasive approach (which included treatment with drugs such as statins) to an invasive approach (which included the same drug treatment options, with the addition of angiography and revascularisation – a medical intervention to restore blood flow).

The team found a 25% reduction in risk of non-fatal heart attacks in patients in the invasive group compared to those in the non-invasive group. In addition, the non-invasive group required over three times as many subsequent procedures (14%) compared to the invasive group (4%).

While the invasive approach was found to be safe, it had no significant impact on the risk of heart-related death during the four-year follow-up.

Professor Kunadian added: “This is the first time this age-group of NSTEMI patients has been studied in such detail, and our findings highlight that age should not be a barrier to individualised care.

“We hope this research will enable better conversations between clinicians and their patients, allowing them to make more informed treatment decisions that are best suited to individuals.”

‘Individualised treatment options’

The findings shed light on the benefits and risks to consider when making individualised treatment decisions, and the researchers hope clinicians will use their findings to inform their practice.

The research was funded by the British Heart Foundation and supported by the National Institute for Health and Care Research (NIHR).

Professor Bryan Williams, Chief Scientific and Medical Officer at the British Heart Foundation, said: “This research addresses the important question of whether older patients, who are often underrepresented in research, could see the same benefits of invasive treatments as younger patients, following a heart attack.

“The decision to undergo coronary angiography and stenting of a blocked artery is never taken lightly. This study provides valuable new information about the risks and benefits, that will help doctors and patients make more informed treatment decisions.

“The BHF is proud to fund pioneering research, and this study demonstrates how supporting our research will help drive life-changing impacts for countless patients.”

Reference: Invasive Treatment Strategy for Older Patients with Myocardial Infarction. New England Journal of Medicine. Vijay Kunadian et al. DOI: 10.1056/NEJMoa2407791