Heart attack treatment: how many arteries to unblock

Heart attacks are usually caused by a blockage in one of the coronary arteries that supply blood to the heart. The most common treatment is an emergency angioplasty, which means opening the blocked artery with an inflatable balloon, and then inserting a metal stent to hold the vessel open. Every year, thousands of people receive emergency angioplasty in the UK.

Angioplasty procedures have transformed heart attack treatment, and work well to get the blood flowing after a heart attack. But if one of your heart’s arteries is blocked, then you have atherosclerosis (the build-up of fatty material inside the arteries) and so there are likely to be problems in others too. About a third of people who have an emergency angioplasty also have narrowed areas in other coronary arteries, which might cause a future heart attack. In the 2010s doctors were unclear whether they should also treat these narrowed arteries, as it would increase the complexity and therefore the risk of the procedure.

Professor Tony Gershlick and his team at the University of Leicester had been at the forefront of research into heart attack treatment since the early 1990s. They designed the BHF-funded CvLPRIT study to find out whether only the ‘culprit’ artery should be treated during emergency angioplasty, or whether other narrowed arteries (bystanders) should also be opened before the patient is discharged from hospital. Their results, published in 2015, showed that treating all the narrowed arteries was linked to a 55 per cent overall reduction in another heart attack, heart failure, the need of further angioplasty or bypass surgery, or death within 12 months of the procedure.

Before this study, opening additional arteries as well as the culprit artery was not recommended during treatment for a heart attack. These findings have been confirmed by several other studies, and now clinical guidelines recommend that doctors consider opening other partly blocked arteries. This means that more people can benefit from treatment that could reduce the risk of further heart attacks and lengthen their lives.

First published 1st June 2021