When a coronary artery becomes acutely blocked during a heart attack, opening it immediately is essential to prevent irreversible damage. However, many patients also have other narrowed vessels that appear during the emergency procedure, raising the question of whether they must be stented right away. A large randomized trial has now shown that treating these additional arteries later is just as safe, cutting the number of procedures in half.

In the trial led by Radboud University Medical Center (Nijmegen, Netherlands) and conducted across 41 hospitals, investigators compared immediate versus delayed stenting in 1,146 patients who had suffered an acute heart attack caused by a fully blocked artery. Patients were randomized to either treat all narrowings during the emergency intervention or to return for additional stenting within six weeks.

Follow-up over three years showed no differences between groups in death, recurrent heart attacks, or hospitalizations for heart failure. The team also found that when patients returned later, only half the initially suspected narrowings required treatment once overall blood flow was assessed by MRI, substantially reducing unnecessary stenting.

The researchers note that while many patients prefer resolving all issues in one visit, real-world clinical pressures mean this is not always possible. The results, published in The New England Journal of Medicine, provide reassurance that stopping after the life-saving intervention is safe and does not harm long-term outcomes. MRI scans in the weeks after recovery can further clarify whether additional stenting is truly needed.

These results may drive a change in current guidelines, which still advise treating all narrowed arteries during the acute phase. The new evidence shows no long-term benefit to the immediate approach and highlights the value of a more accurate assessment after recovery. By reducing unnecessary stenting, cardiologists may improve patient comfort and streamline care.

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