Karachi: A new treatment strategy for heart attack patients, involving the assessment of blood flow before placing stents in additional blocked arteries, has been found to be more effective than conventional angiography-guided treatment in an international clinical trial involving Pakistani experts.
The research, involving cardiologists from the National Institute of Cardiovascular Diseases (NICVD), Karachi, has been published in the New England Journal of Medicine, one of the world’s most prestigious medical journals.
NICVD cardiologists Dr Abdul Hakeem, Dr Jehangir Ali Shah and Dr Ahsan Ali Lakho were among the researchers involved in the international study.
The trial included 1,823 patients suffering from ST-segment elevation myocardial infarction (STEMI), a severe form of heart attack. More than 200 patients were treated at NICVD Karachi as part of the international clinical trial.
According to cardiologists, nearly one in two heart attack patients also have blockages in arteries other than the artery responsible for the acute heart attack. However, not every additional blockage necessarily requires a stent.
The study examined whether these additional narrowed or blocked arteries should be treated solely on the basis of angiography images or whether their functional impact on blood flow should first be assessed using advanced physiology-based techniques, including Angio-FFR.
The patients were divided into two groups. A total of 913 patients underwent physiology-guided complete revascularization, while 910 patients were treated using conventional angiography-guided treatment.
After a median follow-up of nearly 18 months, the rate of major cardiovascular events—including death from any cause, recurrent myocardial infarction, stroke or transient ischemic attack, and ischemia-driven revascularization—was 8.9% in the physiology-guided group, compared with 13.7% in the conventional-treatment group.
Dr Abdul Hakeem said the findings demonstrate that the mere presence of a blockage on an angiogram does not necessarily mean that a stent is required.
He explained that doctors should first determine whether the blockage is actually restricting blood flow to the heart muscle before deciding to implant a stent.
According to Dr Hakeem, approximately half of the additional lesions that might have been treated with stents under conventional angiography-based decision-making did not require stenting after functional assessment.
He said the strategy could represent a major change in heart attack treatment by helping doctors avoid unnecessary stent procedures, while potentially reducing treatment costs and procedure-related complications.
Dr Hakeem said the NICVD interventional cardiology team played an important role in the international trial, with more than 200 patients from Karachi participating in the study.
He described the achievement as a collective success involving the entire medical and research team as well as the patients who participated in the trial and contributed to improving future treatment strategies for heart attack patients.
Former NICVD Chief Executive and head of Aria Hospital Quetta, Dr Sohail Khan, described the publication as a major achievement for Pakistan.
He said researchers and physicians around the world aspire to have their work published in the New England Journal of Medicine, adding that publication of research from a Pakistani public-sector medical institution was a matter of national pride.
Dr Khan said the achievement demonstrated that Pakistani doctors could contribute to global medical science when provided with appropriate research facilities, training and infrastructure.
He stressed the need to strengthen Pakistan’s clinical research culture through better research infrastructure, dedicated clinical trial units, strong ethical oversight and clear government policies.
The study also carries an important message for patients, experts said: identifying a blockage does not automatically mean that a stent is necessary. Patients can ask their cardiologists whether a particular blockage is actually restricting blood flow to the heart muscle and whether stenting is medically justified.