Complete or Culprit-Only PCI in Older Patients with Myocardial Infarction.

Autores de IIS La Fe

• Ramon Moreno Balsalobre

  Autor

• José Luis Díez Gil

  Autor

Participantes ajenos a IIS La Fe

• Biscaglia S
• Guiducci V
• Escaned J
• Lanzilotti V
• Santarelli A
• Cerrato E
• Sacchetta G
• Jurado-Roman A
• Menozzi A
• Amat Santos I
• Ruozzi M
• Barbierato M
• Fileti L
• Picchi A
• Lodolini V
• Biondi-Zoccai G
• Maietti E
• Pavasini R
• Cimaglia P
• Tumscitz C
• Erriquez A
• Penzo C
• Colaiori I
• Pignatelli G
• Casella G
• Iannopollo G
• Menozzi M
• Varbella F
• Caretta G
• Dudek D
• Barbato E
• Tebaldi M
• Campo G
• FIRE Trial Investigators

Grupos

• Grupo de Investigación Clínica y Traslacional en Cardiología

Abstract

BACKGROUND: The benefit of complete revascularization in older patients (=75 years of age) with myocardial infarction and multivessel disease remains unclear. METHODS: In this multicenter, randomized trial, we assigned older patients with myocardial infarction and multivessel disease who were undergoing percutaneous coronary intervention (PCI) of the culprit lesion to receive either physiology-guided complete revascularization of nonculprit lesions or to receive no further revascularization. Functionally significant nonculprit lesions were identified either by pressure wire or angiography. The primary outcome was a composite of death, myocardial infarction, stroke, or any revascularization at 1 year. The key secondary outcome was a composite of cardiovascular death or myocardial infarction. Safety was assessed as a composite of contrast-associated acute kidney injury, stroke, or bleeding. RESULTS: A total of 1445 patients underwent randomization (720 to receive complete revascularization and 725 to receive culprit-only revascularization). The median age of the patients was 80 years (interquartile range, 77 to 84); 528 patients (36.5%) were women, and 509 (35.2%) were admitted for ST-segment elevation myocardial infarction. A primary-outcome event occurred in 113 patients (15.7%) in the complete-revascularization group and in 152 patients (21.0%) in the culprit-only group (hazard ratio, 0.73; 95% confidence interval [CI], 0.57 to 0.93; P = 0.01). Cardiovascular death or myocardial infarction occurred in 64 patients (8.9%) in the complete-revascularization group and in 98 patients (13.5%) in the culprit-only group (hazard ratio, 0.64; 95% CI, 0.47 to 0.88). The safety outcome did not appear to differ between the groups (22.5% vs. 20.4%; P = 0.37). CONCLUSIONS: Among patients who were 75 years of age or older with myocardial infarction and multivessel disease, those who underwent physiology-guided complete revascularization had a lower risk of a composite of death, myocardial infarction, stroke, or ischemia-driven revascularization at 1 year than those who received culprit-lesion-only PCI. (Funded by Consorzio Futuro in Ricerca and others; FIRE ClinicalTrials.gov number, NCT03772743.).

Copyright © 2023 Massachusetts Medical Society.

Keywords

• REVASCULARIZATION; DEFINITIONS; DISEASE; TRIALS