When patients in their 80s are hospitalized with a heart attack, doctors face a tough choice: Is it better to perform an invasive procedure right away, or is it too risky for a frail, older body?
A major study (the EVAOLD trial) presented at the European Society of Cardiology (ESC) Congress in August 2026 provides a clear answer: acting quickly yields the best results.
What did the study examine?
French researchers evaluated 587 patients aged 80 and older who were hospitalized with a specific type of heart attack known as NSTEMI (where a blood clot only partially blocks blood flow to the heart).
The doctors compared two treatment strategies:
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- The routine invasive approach: Patients go straight to a catheterization procedure (coronary angiography) to locate the blockage and have a stent placed to open the narrowed artery if necessary.
- The selective approach: Patients undergo a stress test first. Only those whose results indicate higher risk are sent on for catheterization.
The result: The gentler approach fell short
Researchers hoped the selective strategy would spare many elderly patients from an unnecessary procedure. However, the trial was halted early because the gentler approach performed worse:
- Within one year, 24.1% of patients in the selective strategy group experienced death, a recurrent heart attack, or a stroke.
- By comparison, this occurred in 20.7% of patients who received the routine invasive treatment immediately.
Additionally, researchers found that carrying out stress imaging was difficult to implement in practice among this very old patient group.
What this means for patients and families
Even though invasive catheterization carries risks for older patients, the study confirms that immediate, routine intervention should remain the default standard of care.
Rather than delaying or skipping the procedure across the board, individual health and frailty concerns should be discussed directly with a cardiologist.
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Anyone experiencing chest pain, shortness of breath, or pain radiating to the arm or jaw should call emergency services immediately.
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This article is made and published by Ida-Marie Palm Varbæk, who may have used AI in the preparation.