Heart attack patients often present with multiple blocked coronary arteries, yet standard treatment typically targets only the artery causing the acute event. This approach can leave other blockages untreated, potentially raising future risk. A new large-scale analysis now shows that opening all blocked arteries with stents—an approach known as complete revascularization—reduces deaths and future heart attacks compared with treating only the culprit artery.

In the study led by the Population Health Research Institute (PHRI, Ontario, Canada), researchers analyzed data from six randomized international clinical trials involving 8,836 patients with a median age of 65.8 years. Complete revascularization lowered the combined rate of cardiovascular death or new heart attack to 9.0% over three years, compared with 11.5% among patients who received culprit-only stenting.

The results, published in The Lancet, show that cardiovascular deaths fell from 4.6% to 3.6%, a 24% relative reduction, and all-cause deaths dropped from 8.1% to 7.2%. Benefits were consistent across STEMI and NSTEMI patients and across age groups, on top of standard heart attack therapies such as dual antiplatelet therapy, statins, ACE inhibitors or ARBs, and beta-blockers.

Researchers say the findings resolve long-standing uncertainty about whether complete revascularization improves survival—not just non-fatal events—and position it as a life-prolonging intervention for patients with myocardial infarction. By addressing all blocked coronary arteries, the strategy helps prevent future cardiac events while reducing premature death.

“By reducing premature death, this large international study takes the importance of complete revascularization for patients having a heart attack to a different level,” said Shamir R. Mehta, study chair and PHRI senior scientist. “It firmly establishes complete revascularization as one of the very few life-saving procedures cardiologists now have that not only prevents future heart attacks but now also prolongs life. That’s a major advance that has widespread implications.”

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