Revascularisation is often not considered a priority in the days after a severe heart attack. Previous research investigating the effect of revascularisation on survival for people who have had acute coronary events has produced conflicting results. Ulf Stenestrand from the University Hospital of Linkoping, Sweden, and colleagues assessed the effect of revascularisation and death within one year in individuals who survived for at least two weeks after a serious heart attack.
The investigators compared the one-year mortality data for around 2500 people who had undergone early revascularisation with 19,300 patients not given early revascularisation. Deaths within a year were twice as frequent (5.2%) for patients given conservative treatment compared with those given early revascularisation (2.5%), irrespective of age, sex, baseline characteristics, previous disease, or treatment.
Ulf Stenestrand comments: “This is a Swedish registry study, but even when statistical compensation has been taken into account, there still remains a 50% reduction in the risk of dying within one year after a heart attack if early revascularisation is performed. There are two possible explanations for these new findings: first, that both bypass surgery and balloon angioplasty have better success rates todaythan in the past; second, that this study included patients that were at a higher risk, i.e. sicker patients, than in previous studies. The results of this study should help change the management of patients that have a heart attack towards earlier revascularisation.” (Quote by e-mail; does not appear in published paper).
Contact: Dr Ulf Stenestrand, Department of cardiology, University Hospital of Linkoping, SE 581 85, Linkoping, Sweden; T) +46 13 222000; F) +46 13 157060; E) Stenestrand@riks-hia.c.se
The Lancet