Should heart attack patients have all diseased arteries treated, or just the main culprit?

This study looked at heart attack patients who had more than one heart artery blocked (multivessel coronary disease) and investigated whether is was safer to surgically treat all of the blocked arteries or only treat the main artery causing the heart attack. 

A heart attack occurs when blood flow to the heart is blocked. It is mainly due to a build up of cholesterol in arteries, called coronary arteries, that supply the heart muscle with blood, oxygen and nutrients.

A heart attack can damage part of the heart muscle and immediate treatment is needed to prevent this. A type of heart attack, called an ST segment elevation myocardial infarction (STEMI), is caused by a prolonged period of blocked blood supply that affects a large area of the heart muscle. A STEMI is so called because in an electrocardiogram (ECG), which is used to measure the heart's electrical activity and function, a part of the graph, called an ST segment, is elevated and is thus used to diagnose this particular type of heart attack. 

A procedure used to treat heart attacks is called percutaneous coronary intervention (PCI). This involves the insertion of a small flexible tube (catheter) into an artery, normally in the groin area. The tube is moved along the blood system until it reaches the blocked artery and a small balloon from the tube is then inflated within the artery to dilate it and improve blood flow. A mesh stent is then placed inside the artery to keep it open.

Sometimes more than one coronary (heart) artery is narrowed or blocked. In this case, the patient is said to have multi-vessel coronary artery disease. However, it is not clear whether it is safer to treat all blocked coronary arteries (known as multi-vessel PCI) or to only treat the main artery (culprit artery) causing the heart attack (known as culprit-only PCI). Multi-vessel PCI may help prevent the risk of other narrowed arteries causing a heart attack in the future but it also may put stress on the heart during and shortly after the surgical proedure. 

This article carried out a review of 9 past studies to compare the safety of multi-vessel PCI with culprit-only PCI in patients with STEMI. A total of 5,855 patients were included in the review.

It was found that the odds of having any major heart event (such as a heart attack) within the first 90 days of surgery was 14% lower in patients who received multi-vessel PCI compared to patients who received cuprit-only PCI.

Also 1 year after the surgery patients who received multi-vessel PCI had a 40% reduced likelihood of needing repeat surgery, compared to patients that recieived cuprit-only PCI. 

The study concluded that multi-vessel PCI in patients with a STEMI heart attack is safe and reduces the need to repeat surgery.

Because multi-vessel PCI is treating more than one artery, it increases the risk of surgical complications and may put more stress on the heart during and after surgery.

If you or someone you are at risk of having a heart attack, and have more than one coronary artery blocked, talk to a doctor about the safety and advantages of multi-vessel PCI.