1 research outputs found
Complete vs Culprit-Only Revascularization in Older Patients With Myocardial Infarction and High Bleeding Risk: A Randomized Clinical Trial
IMPORTANCE Patients with high bleeding risk (HBR) have a poor prognosis, and it is not
known if theymay benefit from complete revascularization aftermyocardial infarction (MI).
OBJECTIVE To investigate the benefit of physiology-guided complete revascularization vs
a culprit-only strategy in patients with HBR, MI, and multivessel disease.
DESIGN, SETTING, AND PARTICIPANTS Thiswas a prespecified analysis of the Functional
Assessment in Elderly MI Patients With Multivessel Disease (FIRE) randomized clinical trial
data. FIRE was an investigator-initiated, open-label, multicenter trial. Patients 75 years or
older with MI and multivessel disease were enrolled at 34 European centers from July 2019
through October 2021. Physiology treatment was performed either by angiography- or
wire-based assessment. Patients were divided into HBR or non-HBR categories in accordance
with the Academic Research Consortium HBR document.
INTERVENTIONS Patients were randomized to either physiology-guided complete
revascularization or culprit-only strategy.
MAIN OUTCOMES AND MEASURES The primary outcome comprised a composite of death,
MI, stroke, or revascularization at 1 year. Secondary outcomes included a composite of
cardiovascular death or MI and Bleeding Academic Research Consortium (BARC) types 3 to 5.
RESULTS Among 1445 patients (mean [SD] age, 81 [5] years; 917 male [63%]), 1025 (71%) met
HBR criteria. Patients with HBR were at higher risk for the primary end point (hazard ratio
[HR], 2.01; 95%CI, 1.47-2.76), cardiovascular death or MI (HR, 1.89; 95%CI, 1.26-2.83), and
BARC types 3 to 5 (HR, 3.28; 95%CI, 1.40-7.64). The primary end point was significantly
reduced with physiology-guided complete revascularization as compared with culprit-only
strategy in patients with HBR (HR, 0.73; 95%CI, 0.55-0.96). No indication of interaction
was noted between revascularization strategy and HBR status for primary and secondary
end points.
CONCLUSIONS AND RELEVANCE HBR status is prevalent among older patients with MI,
significantly increasing the likelihood of adverse events. Physiology-guided complete
revascularization emerges as an effective strategy, in comparison with culprit-only
revascularization, for mitigating ischemic adverse events, including cardiovascular death
and MI