Age alone no barrier for heart attack treatment

Elderly patients suffering the most common type of heart attack may benefit from more invasive treatment, according to new research we've part-funded.

The research looks at elderly patients admitted to hospital with a type of heart attack called NSTEMI (non-ST segment elevated myocardial infarction). It found patients who underwent invasive treatment with a coronary angiogram, followed up with bypass surgery or coronary stenting as appropriate, had higher survival rates than those who were treated with medication alone. Patients who had coronary angiograms were also less likely to be re-admitted to hospital with a second heart attack or heart failure.

Coronary angiograms are specialist X-rays to identify blockages in the blood supply to the heart. They can help a clinician determine the cause of an NSTEMI heart attack and decide on effective treatment, such as increasing blood flow through a coronary stent or bypass grafting and setting the optimum level of medication. 

Conflicting evidence

Previous trials have shown increased survival rates in younger patients with NSTEMI heart attacks following invasive treatment, but there has been conflicting evidence as to whether these benefits extend into patients over 80. Only 38 percent of NSTEMI patients in this older age group currently receive invasive treatment, compared to 78 percent of the under 60s.

Professor Sir Nilesh Samani, Medical Director at the British Heart Foundation said:“This research will give confidence to doctors on the best course of treatment for elderly people who suffer heart attacks. Decades of research has fine-tuned our understanding of how to best treat heart attacks and ensure people go on to live long and healthy lives. However, evidence around optimal treatments for older people over 80 has been less clear.” 

 “While the decisions about the best way to treat any elderly patient will depend on their individual circumstance – this study shows that age alone should not be a barrier to patients receiving life saving procedures for heart attacks.” 

In total, 1500 patients were included in the study, with just over half having invasive treatment. After five years, 31 percent of those in the invasive treatment group had died, compared to 61 percent in the non-invasive group. 

The study was conducted by researchers at Imperial College Healthcare NHS Trust and Imperial College London and led by Dr Amit Kaura, British Heart Foundation Clinical Research Fellow and NIHR Clinical Research Fellow. 

Life saving treatment

The team estimate that if all patients had received invasive treatment, just 36 percent would have died, compared to 55 percent if all had received non-invasive treatment. These figures take into account over 70 variables across the group that might have affected prognosis, such as other medical conditions.

The analysis also showed that patients were at no greater risk of stroke or bleeding if they received invasive treatment, as there were similar rates across both groups. Patients who had invasive treatment were also a third less likely to be re-admitted to hospital for heart failure or heart attack.

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