Complete vs Culprit-Only Revascularization in Older Patients With Myocardial Infarction and High Bleeding Risk

• DOI: 10.1001/jamacardio.2024.0804
• Publication Date: 2024-05-08T15:01:11Z
• Authors: Andrea Erriquez; Gianluca Campo; Vincenzo Guiducci; Javier Escaned; Raul Moreno; Gianni Casella; Mila Menozzi; Enrico Cerrato; Giorgio Sacchetta; Alberto Menozzi; Ignacio Amat Santos; Enrique Gutiérrez...; Roberto Scarsini; Giuseppe Vadalà; Giuseppe Andò; José Luis Díez-Gil; Sergio Musto d’Amore; Alessandro Capecchi; Iginio Colaiori; Francesco Gallo; Rita Pavasini; Andrea Marrone; Graziella Pompei; Valerio Lanzilotti; Dariusz Dudek; Emanuele Barbato; Matteo Tebaldi; Simone Biscaglia
• Keywords: Culprit; Clinical endpoint; Stroke

Importance Patients with high bleeding risk (HBR) have a poor prognosis, and it is not known if they may benefit from complete revascularization after myocardial infarction (MI). Objective To investigate the of physiology-guided vs culprit-only strategy in patients HBR, MI, multivessel disease. Design, Setting, Participants This was prespecified analysis Functional Assessment Elderly MI With Multivessel Disease (FIRE) randomized clinical trial data. FIRE an investigator-initiated, open-label, multicenter trial. 75 years or older disease were enrolled at 34 European centers July 2019 through October 2021. Physiology treatment performed either by angiography- wire-based assessment. divided into HBR non-HBR categories accordance Academic Research Consortium document. Interventions to strategy. Main Outcomes Measures The primary outcome comprised composite death, stroke, 1 year. Secondary outcomes included cardiovascular death Bleeding (BARC) types 3 5. Results Among 1445 (mean [SD] age, 81 [5] years; 917 male [63%]), 1025 (71%) met criteria. higher for end point (hazard ratio [HR], 2.01; 95% CI, 1.47-2.76), (HR, 1.89; 1.26-2.83), BARC 5 3.28; 1.40-7.64). significantly reduced as compared 0.73; 0.55-0.96). No indication interaction noted between status secondary points. Conclusions Relevance prevalent among increasing likelihood adverse events. Physiology-guided emerges effective strategy, comparison revascularization, mitigating ischemic events, including MI. Trial Registration ClinicalTrials.gov Identifier: NCT03772743