If a male 89 has a heart attack is in icu with low blood pressure has had blood thinners should there be operation at some point for heart blockage?

Not necessarily: if the angiogram was "fine" it was probably not a blockage that caused the heart attack. they probably had a heart attack that was caused by mismatch between the heart muscle's oxygen needs and the body ability to supply it- low blood pressure, low oxygen, and sepsis are a few of the causes of this type of heart attack. in these cases the heart attack is treated by treating the underlying cause

MI and need for surg: The decision to operate is based on evidence of coronary vascular disease. It appears that the angiogram was negative recently. He also had valvular disease which complicates things. Other factors come into play, the rest of his medical history will be used to determine his risks for surgery if needed. When the cardiologist determines why the heart attack occurred you can address fixing it.