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Bollywood Filmmaker Kuku Kohli died on Tuesday, August 25, at Kokilaben Dhirubhai Ambani Hospital in Mumbai, two days after being admitted following a heart attack. Doctors reportedly placed a coronary stent as part of his treatment, but his condition later worsened. He collapsed at the hospital and, despite attempts to revive him, was declared dead at around 5 pm. Kohli was 77. He is survived by his wife, actor Aruna Irani, and his two children, Pooja and Karishma, from his first marriage to Rita Kohli. His death has raised an important question: If a stent opens a blocked artery, how can a person still die after a heart attack? According to Dr Sameer Bhate, Head, Cardiovascular and Thoracic Surgery, Amrita Hospital, Faridabad, a stent can restore blood flow, but it cannot reverse heart muscle that has already been permanently damaged.
A Stent Does Not Reverse Existing Heart Damage
"A stent can open up a blocked coronary artery, but it cannot undo a heart attack that has already damaged the myocardium. This difference may account for why a patient can get worse despite technically successful angioplasty," says Dr Bhate. When a coronary artery becomes completely blocked, the portion of the heart muscle supplied by that artery is deprived of oxygen. The longer the blockage persists, the greater the risk of permanent damage. Angioplasty and stenting can reopen the artery and limit further injury, but they cannot bring back heart muscle that has already died. "The precise cause of death cannot be known without the clinical records. But medically speaking, there could be a number of mechanisms at work," Dr Bhate explains.
Severe Heart Muscle Damage Can Be Life-Threatening
One of the biggest concerns after a major heart attack is the extent of damage to the heart muscle. If a major coronary artery remains blocked for a prolonged period, a large portion of the heart may be affected before blood flow is restored. Even after successful angioplasty, the damaged heart may not be able to pump blood effectively. This can lead to complications such as heart failure, cardiogenic shock or dangerous changes in the heart's electrical rhythm. Cardiogenic shock occurs when the heart becomes too weak to pump enough blood to vital organs. It is one of the most serious complications of a major heart attack and carries a high risk of death even with advanced medical treatment.
Dr Ashish Jai Kishan, Senior Consultant, Cardiology, Fortis escort heart institute, says, "The period following a heart attack and angioplasty is particularly important. The heart muscle may already have suffered damage, and patients can develop abnormal heart rhythms, reduced pumping function, recurrent blockage or other complications. This is why close monitoring during the early period after a heart attack and angioplasty is so important." It is equally important to understand that angioplasty and stenting are only one part of the treatment of coronary artery disease. "Risk factors such as high blood pressure, diabetes, high cholesterol, smoking, obesity, physical inactivity and an unhealthy diet can continue to damage the arteries even after a successful angioplasty," he adds.
Dangerous Heart Rhythms Can Occur After A Heart Attack
Another possible complication is ventricular fibrillation, a life-threatening abnormal heart rhythm in which the heart's lower chambers quiver instead of pumping blood effectively. Dr Bhate says such rhythm disturbances can be particularly dangerous during the early period after an acute myocardial infarction. A patient may therefore experience sudden cardiac arrest even if the artery treated with a stent remains open.
Can A Stent Itself Develop A Blockage?
In rare cases, a clot can form inside a coronary stent. This is known as stent thrombosis. Modern drug-eluting stents have made this complication uncommon, but when it occurs, it can abruptly block blood flow through the treated artery and cause another heart attack. One important preventable risk is stopping prescribed antiplatelet medicines too early. "Never stop taking antiplatelet medication without consulting your doctor," says Dr Bhate. These medicines, often prescribed as a combination after stenting, help prevent blood clots from forming inside the stent.
A Stent Treats The Blockage, Not The Entire Disease
Another important point is that coronary artery disease usually does not affect only one isolated area. A stent treats the specific narrowing responsible for the immediate problem, but it does not eliminate the underlying process of atherosclerosis. Other plaques may remain elsewhere in the coronary arteries and can potentially become unstable, rupture and cause another blockage. This is why patients with coronary artery disease may require ongoing treatment even after a successful angioplasty.
What Happens After A Heart Attack?
Recovery after a heart attack involves much more than simply opening the blocked artery. Doctors assess the extent of heart muscle damage, pumping function, heart rhythm, remaining blockages and other risk factors before deciding on further treatment. Long-term prevention may include:
- Taking prescribed antiplatelet and other heart medicines
- Controlling cholesterol
- Managing blood pressure and diabetes
- Stopping smoking
- Following a heart-healthy diet
- Gradually returning to physical activity under medical guidance
- Participating in cardiac rehabilitation when recommended
These measures are aimed at reducing the risk of another heart attack and protecting the remaining heart muscle. A coronary stent can be lifesaving because it restores blood flow to a blocked artery. But it is not a cure for coronary artery disease, nor can it reverse heart muscle that has already been permanently damaged. As Dr Bhate puts it, "An open artery after a heart attack is a big win, but not a guarantee of safety." The outcome after a heart attack depends on several factors, including how quickly blood flow is restored, how much heart muscle has been damaged, the heart's pumping function, the stability of its rhythm and whether significant disease remains elsewhere in the coronary arteries
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