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  3. Physiology-Guided Complete Revascularization in Older Patients With Myocardial Infarction: Three-Year Outcomes of a Randomized Clinical Trial.

Physiology-Guided Complete Revascularization in Older Patients With Myocardial Infarction: Three-Year Outcomes of a Randomized Clinical Trial.

Fecha de publicación: Fecha Ahead of Print:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Biscaglia S
  • Erriquez A
  • Guiducci V
  • Escaned J
  • Moreno R
  • Lanzilotti V
  • Santarelli A
  • Cerrato E
  • Sacchetta G
  • Menozzi A
  • Amat-Santos I
  • Ruozzi M
  • Barbierato M
  • Fileti L
  • Picchi A
  • Pavasini R
  • Cimaglia P
  • Colaiori I
  • Casella G
  • Menozzi M
  • Cavazza C
  • Caretta G
  • Scarsini R
  • D'Amico G
  • Vadalà G
  • Pilato G
  • Moscarella E
  • Tebaldi M
  • Campo G

Grupos

Abstract

IMPORTANCE: Complete revascularization in older patients with myocardial infarction (MI) and multivessel disease has been shown to reduce cardiovascular death and MI at 1 year. However, the durability of this benefit over longer follow-up periods has been questioned by recent studies. OBJECTIVE: To determine whether the benefit of physiology-guided complete treatment, compared with culprit-only treatment, is sustained at 3 years in older patients with MI and multivessel disease. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial, Functional Assessment in Elderly MI Patients With Multivessel Disease (FIRE), was an investigator-initiated, multicenter, prospective, superiority trial conducted at 34 centers across 3 countries from July 18, 2019, to October 25, 2021. Participants were patients with MI (either ST segment or non-ST segment elevated) and multivessel disease who were hospitalized after successful treatment of the culprit lesion. Major exclusion criteria included a nonculprit lesion in the left main coronary artery and unclear identification of the culprit lesion. Data analysis was performed from March to May 2025. INTERVENTIONS: Culprit-only treatment or physiology-guided complete revascularization of nonculprit lesions. MAIN OUTCOMES AND MEASURES: The primary outcome was a patient-oriented composite end point of death, MI, stroke, or ischemia-driven revascularization. Secondary end points included a composite of cardiovascular death or MI and rate of heart failure hospitalizations. RESULTS: Among 1445 patients enrolled in the trial, the median (IQR) age was 80 (77-84) years; 917 patients were male (63.5%) and 528 female (36.5%). At 3 years, the primary outcome occurred in 165 patients (22.9%) in the physiology-guided complete revascularization group and 216 patients (29.8%) in the culprit-only group (hazard ratio [HR], 0.72; 95% CI, 0.58-0.88; P = .002). The key secondary outcome of cardiovascular death or MI occurred in a significantly lower number of patients in the physiology-guided complete revascularization group (92 patients [12.8%]) compared with the culprit-only group (132 patients [18.2%]; HR, 0.66; 95% CI, 0.50-0.88; P = .004). Hospitalizations for heart failure were more frequent in the culprit-only group compared with the physiology-guided complete group (143 [19.7%] vs 103 [14.3%]; HR, 0.73; 95% CI, 0.54-0.97; P = .03). CONCLUSIONS AND RELEVANCE: In patients 75 years or older with MI and multivessel disease, the benefit of physiology-guided complete revascularization over culprit-lesion-only treatment was sustained at 3 years. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03772743.

Datos de la publicación

ISSN/ISSNe:
2380-6583, 2380-6591

JAMA Cardiology  AMER MEDICAL ASSOC

Tipo:
Article
Páginas:
1130-1137
PubMed:
40879426
Factor de Impacto:
8,324 SCImago ℠
Cuartil:
Q1 SCImago ℠

Citas Recibidas en Web of Science: 10

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