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Renal Function-Stratified Comparison of Complete vs Culprit-Only Revascularization in Older Patients With Myocardial Infarction and Multivessel Disease

Fecha de publicación:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Cantone A.
  • Verardi F.M.
  • Vadalà G.
  • Guiducci V.
  • Casella G.
  • Cavazza C.
  • Cerrato E.
  • Sacchetta G.
  • Moreno R.
  • Serenelli M.
  • Amat Santos I.
  • Scarsini R.
  • Picchi A.
  • Cocco M.
  • Colaiori I.
  • Barbierato M.
  • Arioti M.
  • Marchini F.
  • Pavasini R.
  • Caglioni S.
  • Lanzilotti V.
  • Menozzi M.
  • Erriquez A.
  • Campo G.
  • Biscaglia S.

Grupos

Abstract

Background Chronic kidney disease is a major risk factor for cardiovascular events and complicates revascularization decisions in patients with myocardial infarction (MI). However, data on optimal strategies in this population remain limited. Objectives The authors sought to determine whether the benefits of physiology-guided complete revascularization are consistent across subpopulations of older MI patients stratified by renal function. Methods In the FIRE (Functional Assessment in Elderly MI Patients with Multivessel Disease (FIRE) trial, 1,445 patients aged =75 years with MI and multivessel disease were randomized to receive physiology-guided complete or culprit-only revascularization. Patients were stratified based on baseline estimated glomerular filtration rate (eGFR) (=60 vs <60 mL/min/1.73 m2). The primary outcome was a 3-year composite of death, MI, stroke, or ischemia-driven revascularization. Results A total of 662 patients (45.8 %) had eGFR <60 mL/min/1.73 m2. The primary endpoint occurred in 222 patients (33.5%) with eGFR <60 vs 159 patients (20.3%) with eGFR =60 mL/min/1.73 m2. Lower eGFR was independently associated with higher risk of the primary endpoint (adjusted HR: 1.42; 95% CI: 1.15–1.76; P < 0.001). Complete revascularization reduced the primary endpoint in both subgroups (HR: 0.68; 95% CI: 0.52-0.89 for patients with eGFR <60 mL/min/1.73 m2; HR: 0.80; 95% CI: 0.59-1.10 for those with eGFR =60 mL/min/1.73 m2) without significant interaction ( P > 0.42). HR for complete vs culprit-only revascularization remained stable across the continuous eGFR range. Contrast-associated acute kidney injury occurred in 245 patients (17%), increased progressively across Kidney Disease: Improving Global Outcomes (KDIGO) stages ( P < 0.001), and was similar between treatment arms (HR: 1.11; 95% CI: 0.87-1.43). Conclusions Kidney function remains a strong prognostic factor in older MI patients. Physiology-guided complete revascularization is effective regardless of renal function and may provide greater absolute clinical benefit in patients with chronic kidney disease due to their elevated baseline risk. Copyright © 2025. Published by Elsevier Inc.

Datos de la publicación

ISSN/ISSNe:
1936-8798, 1876-7605

JACC-Cardiovascular Interventions  ELSEVIER SCIENCE INC

Tipo:
Article
Páginas:
2849-2859
PubMed:
41137841
Enlace a otro recurso:
www.scopus.com
Factor de Impacto:
3,595 SCImago ℠
Cuartil:
Q1 SCImago ℠

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Keywords

  • Age Factors; Aged; Aged, 80 and over; Coronary Artery Disease; Female; Glomerular Filtration Rate; Humans; Kidney; Male; Myocardial Infarction; Myocardial Revascularization; Non-ST Elevated Myocardial Infarction; Percutaneous Coronary Intervention; Renal Insufficiency, Chronic; Risk Assessment; Risk Factors; ST Elevation Myocardial Infarction; Time Factors; Treatment Outcome; contrast medium; acute kidney failure; aged; Article; atrial fibrillation; cerebrovascular accident; chronic kidney failure; clinical outcome; contrast induced nephropathy; controlled clinical trial; controlled study; culprit only revascularization; current smoker; diabetes mellitus; dyslipidemia; estimated glomerular filtration rate; event free survival; female; geriatric surgery; heart left ventricle ejection fraction; heart muscle revascularization; hospital admission; human; hypertension; intermethod comparison; left coronary artery; major clinical study; male; multicenter study; non ST segment elevation myoca

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