Today, patients that are brought to the hospital with a acute myocardial infarction, will immediately be given a stent in the blocked coronary artery responsible for the myocardial infarction. However, 30% of them will have other blockages in their coronary arteries other than the cause of the myocardial infarction: these are treated at a later stage with stents. If you have several blocked coronary arteries, you will have an increased risk of mortality and complications after a myocardial infarction in comparison to someone with just one blocked coronary artery. Which is why patients with other blockages are given a so-called complete revascularisation.
29 European hospitals
The Biovasc study examined whether it is better to immediately treat patients with two or more blocked coronary arteries in one go, or to first tackle the main cause and treat the other blockages at later points in time.
In total 1,525 patients from 29 European hospitals participated in the study that ran from June 2018 to October 2021. One group of patients was given a complete revascularisation and the other group a staged treatment after the first myocardial infarction. There was a one year follow-up of the patients.
Conclusion
In terms of mortality there was no difference between the 2 groups: 1.8% of the patients that were given an immediate complete revascularisation died, versus 1.2% of the patients with a staged revascularisation. The risk of having an acute stroke was also similar: 1.4% chance in the first group and 1,6% chance in the second group.
However, the groups did show significant differences in the risk of a new myocardial infarction: 1.8% of the patients with an immediate complete treatment got a second myocardial infarction, versus 4.5% of the patients that were treated in stages. The study was able to prove that a staged treatment coincided with more myocardial infarctions and more unplanned percutaneous interventions with stents. Immediate complete treatment of the blocked coronary arteries seems to be better to avoid new myocardial infarctions in the first 30 days after the first myocardial infarction.
At UZ Leuven prof. dr. Johan Bennett participated in the study which included the follow-up of a large number of patients. The Erasmus-ziekenhuis in Rotterdam was the principal investigator of the study and collected the data. Prof. dr. Bennett, interventional cardiologist at UZ Leuven: “The main conclusion is that doctors should not be concerned if they want to perform a complete revascularisation during the procedure, especially if there is two-vessel disease or a simple lesion that can be treated quickly. Total treatment is safe and feasible and you're likely to be doing the patient a better service without any additional risk. The finding of this studie can lead to a modification of the European guidelines for the treatment of acute myocardial infarction.”
The Biovasc study was published in the leading medical journal The Lancet.