Publish date: 28 August 2020

Elderly patients suffering the most common type of heart attack may benefit from more invasive treatment, new research involving UCLH has shown.

The study, published in The Lancet, draws on data captured over seven years from 1500 patients aged 80 or over. It was conducted by researchers from the National Institute of Health Research Health Informatics Collaborative (NIHR-HIC), led by Imperial College Healthcare NHS Trust and Imperial College London and involving the NIHR Biomedical Research Centre at UCLH and UCL and the BRC Clinical and Research Informatics Unit.

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.

Researchers said the results of this study mean clinicians can be confident of the benefits of invasive treatment for this group of patients.

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. Only 38 percent of NSTEMI patients in this older age group currently receive invasive treatment, compared to 78 percent of the under 60s.

A total of 1500 patients over 80 who were diagnosed with an NSTEMI heart attack at five hospitals between 2010 and 2017 were included in the analysis, 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.

The data used in the study was gathered through the National Institute for Health Research Health Informatics Collaborative (NIHR-HIC), which involves: Imperial College Healthcare NHS Trust, Oxford University Hospitals NHS Foundation Trust, University College London Hospitals NHS Foundation Trust, King’s College Hospital NHS Foundation Trust and Guy’s and St Thomas’ NHS Foundation Trust.