New research published in The Lancet has found that elderly patients suffering the most common type of heart attack may benefit from more invasive treatment.
Guy’s and St Thomas’ NHS Foundation Trust clinicians and researchers from our NIHR BRC at Guy’s and St Thomas’ worked on this study with colleagues from the National Institute of Health Research Health Informatics Collaborative (NIHR-HIC), which includes King’s College Hospital NHS Foundation Trust, Imperial College Healthcare NHS Trust, Oxford University Hospitals NHS Foundation Trust and University College London Hospitals NHS Foundation Trust.
The research looked at elderly patients admitted to hospital with a type of heart attack called an 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.
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.
The study identified just under 2,000 patients aged over 80 who were diagnosed with an NSTEMI heart attack at five hospitals between 2010 and 2017. To ensure the robustness of the study, the researchers used sophisticated statistical techniques to apply the kind of criteria used in a clinical trial, to determine which of these patients would be included in the analysis.
In total, 1500 patients were included, with just over half having invasive treatment. After five years, 36 percent of those in the invasive treatment group had died, compared to 55 percent in the non-invasive group. These figures take into account over 70 variables 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.
Professor Ajay Shah, Cardiovascular Theme lead at our BRC at Guy’s and St Thomas’ and BHF Professor of Cardiology & Head of the School of Cardiovascular Medicine & Sciences at King’s College London said: “This research has shown us that elderly patients respond well to treatments for NSTEMI which we had previously thought were unsuitable. This will improve the way we look after these patients and potentially increase their chance of survival.”
Professor Divaka Perera, Professor of Cardiology, King’s College London and Consultant Cardiologist at Guy’s & St Thomas’ NHS Foundation Trust added: “Combining data across the NIHR’s BRCs has allowed us to gain powerful insights that may not have been apparent by looking at data from individual centres alone.“
The study was funded by the NIHR Imperial Biomedical Research Centre and led by Imperial College Healthcare NHS Trust and Imperial College London.