Data di Pubblicazione:
2023
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.).
Tipologia CRIS:
14.a.1 Articolo su rivista
Elenco autori:
Biscaglia, Simone; Guiducci, Vincenzo; Escaned, Javier; Moreno, Raul; Lanzilotti, Valerio; Santarelli, Andrea; Cerrato, Enrico; Sacchetta, Giorgio; Jurado-Roman, Alfonso; Menozzi, Alberto; Amat Santos, Ignacio; Díez Gil, José Luis; Ruozzi, Marco; Barbierato, Marco; Fileti, Luca; Picchi, Andrea; Lodolini, Veronica; Biondi-Zoccai, Giuseppe; Maietti, Elisa; Pavasini, Rita; Cimaglia, Paolo; Tumscitz, Carlo; Erriquez, Andrea; Penzo, Carlo; Colaiori, Iginio; Pignatelli, Gianluca; Casella, Gianni; Iannopollo, Gianmarco; Menozzi, Mila; Varbella, Ferdinando; Caretta, Giorgio; Dudek, Dariusz; Barbato, Emanuele; Tebaldi, Matteo; Campo, Gianluca; FIRE Trial Investigators: Gianluca Campo, ; Biscaglia, Simone; Penzo, Carlo; Matese, Camilla; Venturoli, Elisa; Beatrice De Carolis, ; Maio, Daniele; Viola, Martina; Mosele, Elisa; Manzalini, Chiara; Sacchetta, Giorgio; Contarini, Marco; Artale, Claudia; Guiducci, Vincenzo; Pignatelli, Gianluca; Colaiori, Iginio; Sergio Musto D'Amore, ; Bosi, Davide; Valli, Linda; Rosa De Mola, ; Santarelli, Andrea; Menozzi, Mila; Cavazza, Caterina; Fileti, Luca; Rubboli, Andrea; Aquilina, Matteo; Balducelli, Marco; Moretti, Carolina; Varbella, Ferdinando; Cerrato, Enrico; Tomassini, Francesco; Rolfo, Cristina; Franzè, Alfonso; Piedimonte, Giulio; Zanda, Greca; Luca Lo Savio, ; Casella, Gianni; Nobile, Giampiero; Capecchi, Alessandro; Lanzilotti, Valerio; Iannopollo, Gianmarco; Verardi, Roberto; Coutsoumbas, Barbara; Maffia, Flavio; Giannini, Francesco; Ruggiero, Rossella; Argentino, Vincenzo; Bonomo, Dino; Milazzo, Diego; Pilato, Gerlando; Vaccaro, Giovanni; Ilenia Di Liberto, ; Ruozzi, Marco; Magnavacchi, Paolo; Iaccarino, Daniele; Landino, Pietro; Corbisiero, Alfonsina; Domenico Di Girolamo, ; Vadalà, Giuseppe; Rocco, Giunta; Graziano, Trovato; Menozzi, Alberto; Caretta, Giorgio; Arena, Marco; Andò, Giuseppe; Costa, Francesco; Vizzari, Giampiero; Virga, Vittorio; Saporito, Francesco; Pighi, Michele; Mainardi, Andrea; Francesco Della Mora, ; Scarsini, Roberto; Ribichini, Flavio; Picchi, Andrea; Massoni, Alberto; Limbruno, Ugo; Berni, Andrea; Rigattieri, Stefano; Barbierato, Marco; D'Amico, Gianpiero; Gallo, Francesco; D'Amico, Maurizio; Gambino, Alfonso; Calabrò, Paolo; Fimiani, Fabio; Moscarella, Elisabetta; Coletta, Silvio; Michele De Benedictis, ; Pavani, Marco; Barbero, Umberto; Moncalvo, Cinzia; Javier Escaned Barbosa, ; Vergará, Carlos; Mcinerney, Angela; Mejia, Hernán; Vedia, Oscar; Gomez, Ana; Moreno, Raul; Caro-Codon, Juan; Fernandez-Figares, Virginia; Galeote, Guillermo; Jimenez-Valero, Santiago; Jurado-Roman, Alfonso; Labrador, María; Mediavilla, Guiomar; Rosillo, Sandra; Fernandez-Aviles, Francisco; Enrique Gutierrez Ibañes, ; Vazquez, Sandra; Andres Iñiguez Romo, ; Guillermo Bastos Fernández, ; Alberto Ortiz Sáez, ; Jose Antonio Baz Alonso, ; Antonio Alejandro de Miguel Castro, ; Víctor Alfonso Jiménez Díaz, ; Saleta Fernández Barbeira, ; Rodrigo Estévez Loureiro, ; Rocío González Ferreiro, ; Pablo Juan Salvadores, ; Ana Isabel Ferrero Martínez, ; Sonia Soto Fernández, ; María José Rodríguez Pérez, ; María Pena Martínez, ; Fernando Lozano Ruiz-Poveda, ; Maria Lopez Lluva, ; Abellan, Jose; Perez, Ignacio; José Luis Díez Gil, ; Vicente Jimenez Cruz, ; Bernabé López Ledesma, ; Ocaranza-Sanchez, Raymundo; Melisa Santás Álvarez, ; Jeremias Bayón Lorenzo, ; Rubén Vila Abelleira, ; Alba Abellás Sequeirós, ; Vila, Rubén; Miranda, Susana; Ramiro Trillo Nouche, ; Diego Lopez Otero, ; Ana Belen Cid Alvarez, ; Juan Carlos Santamaria Pena, ; Diana Pereiro Montes, ; Ramón Calviño Santos, ; Jose Manuel Vazquez Rodriguez, ; Elena Paz Misiego, ; Ignacio, J Amat Santos; Redondo, Alfredo; Campo, Alberto; Peral, Julio; Baladron, Carlos; María José Coya, ; Dudek, Dariusz; Giszterowicz, Dawid; Dobrowolski, Wojciech; Nosal, Marcin; Marosz, Rafał; Wilusz, Piotr; Paździerz, Jarosław; Żywiec, Piotr; Szynal, Sławomir; Corsi, Stefania; Sivieri, Marzia; Tebaldi, Matteo; Escaned
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