FIRE
Trial question
What is the role of physiology-guided complete revascularization in older patients with myocardial infarction and multivessel disease?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
37.0% female
63.0% male
N = 1445
1445 patients (528 female, 917 male)
Inclusion criteria: older patients, ≥ 75 years, with myocardial infarction and multivessel disease who were undergoing PCI of the culprit lesion
Key exclusion criteria: inability to identify a clear culprit lesion; localization of the nonculprit lesion in the left main coronary artery; planned or previous surgical revascularization; life expectancy < 1 year
Interventions
N=720 complete revascularization (physiology-guided complete revascularization of nonculprit lesions)
N=725 culprit-only revascularization (no physiological assessment or revascularization of nonculprit lesions)
Primary outcome
Composite of death, myocardial infarction, stroke, or any revascularization at 1 year
15.7
21
21.0 %
15.8 %
10.5 %
5.3 %
0.0 %
Complete
revascularization
Culprit-only
revascularization
Significant
decrease ▼
NNT = 18
Significant decrease in composite of death, myocardial infarction, stroke, or any revascularization at 1 year (15.7% vs. 21%; HR 0.73, 95% CI 0.57 to 0.93)
Secondary outcomes
Borderline significant decrease in cardiovascular death or myocardial infarction (8.9% vs. 13.5%; HR 0.64, 95% CI 0.47 to 0.88)
Borderline significant decrease in death from any cause (9.2% vs. 12.8%; HR 0.7, 95% CI 0.51 to 0.96)
Borderline significant decrease in myocardial infarction (4.4% vs. 7%; HR 0.62, 95% CI 0.4 to 0.97)
Safety outcomes
No significant differences in contrast-associated AKI, stroke, or bleeding.
Conclusion
In older patients, ≥ 75 years, with myocardial infarction and multivessel disease who were undergoing PCI of the culprit lesion, complete revascularization was superior to culprit-only revascularization with respect to the composite of death, myocardial infarction, stroke, or any revascularization at 1 year.
Reference
Simone Biscaglia, Vincenzo Guiducci, Javier Escaned et al. Complete or Culprit-Only PCI in Older Patients with Myocardial Infarction. N Engl J Med. 2023 Sep 7;389(10):889-898.
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