Does early treatment of heart attacks have long-term benefits?

This study compared the effects of early and delayed invasive treatment in people with heart attacks. It was determined that early invasive treatment reduced the risk of having another heart attack in the short term, but did not affect the risk of mortality or long-term risk of heart attacks, compared to delayed treatment.

Invasive treatment for heart attacks involves percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). PCI is a non-surgical procedure where narrow or blocked arteries are widened or unblocked. CABG is a surgical procedure where a healthy blood vessel is taken and connected to a blocked artery. This creates a ‘bypass’ around the blocked artery.

Early invasive treatment of heart attacks appears to have benefits in the short term. However, the long-term effects are still under investigation.

323 adults who had heart attacks participated in this study. 162 received early invasive treatment. 161 received delayed invasive treatment. The average time until treatment was 1.4 hours for the early group, and 61 hours for the delayed group. They were followed up 30 days, 1 year, 2 years, and 3 years after treatment.

The early group had a 68% lower chance of having another heart attack or dying in the first 30 days after treatment than the delayed group. After 3 years they had a 50% lower chance. This was mainly due to a higher risk of heart attacks in the delayed group during the period before treatment was given. After the first 30 days the risk of having another heart attack was the same in both groups.

Overall mortality rates were similar in both the early and delayed groups at all times during the study. Those who had another heart attack in the first 30 days after treatment tended to have a higher mortality rate after 3 years.

The study concluded that early invasive treatment of heart attacks reduces the risk of having another heart attack in the first 30 days after treatment, when compared with delayed invasive treatment. However, early treatment had no effect on mortality at any time, or risk of heart attacks after 30 days, compared with delayed treatment.

The delayed group was more likely to have CABG, while the early group was more likely to have PCI. This may have influenced the results, but was not examined in the study. Furthermore, this study examined only a small number of people, which may have limited comparisons.