Marta Cocco, Gianluca Campo, Vincenzo Guiducci, Gianni Casella, Caterina Cavazza, Enrico Cerrato, Giorgio Sacchetta, Raul Moreno, Alberto Menozzi, Ignacio Amat Santos, José Luis Díez Gil, Roberto Scarsini, Andrea Picchi, Giuseppe Vadalà, Gerlando Pilato, Iginio Colaiori, Marco Barbierato, Manfredi Arioti, Rita Pavasini, Valerio Lanzilotti, Mila Menozzi, Ferdinando Varbella, Andrea Erriquez, Simone Biscaglia
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引用次数: 0
Abstract
Background: The effectiveness of complete revascularization is well established in patients with ST-segment elevation myocardial infarction (STEMI), but it is less investigated in those with non-ST-segment elevation myocardial infarction (NSTEMI).
Objectives: This study aimed to assess whether complete revascularization, compared with culprit-only revascularization, was associated with consistent outcomes in older patients with STEMI and NSTEMI.
Methods: In the FIRE (Functional Assessment in Elderly MI Patients with Multivessel Disease) trial, 1,445 older patients with myocardial infarction (MI) were randomized to culprit-only or physiology-guided complete revascularization, stratified by STEMI (n = 256 culprit-only vs n = 253 complete) and NSTEMI (n = 469 culprit-only vs n = 467 complete). The primary outcome comprised a composite of death, MI, stroke, or revascularization at 1 year. The key secondary outcome included a composite of cardiovascular death or MI at 1 year.
Results: In the overall study population, physiology-guided complete revascularization reduced both primary and key secondary outcomes. The primary outcome occurred in 54 (21.1%) STEMI patients randomized to culprit-only vs 41 (16.2%) STEMI patients of the complete group (HR: 0.75; 95% CI: 0.50-1.13) and in 98 (20.9%) NSTEMI patients randomized to culprit-only vs 72 (15.4%) NSTEMI patients of the complete group (HR: 0.71; 95% CI: 0.53-0.97), with negative interaction testing (P for interaction, 0.846). Similarly, no signal of heterogeneity with respect to the initial clinical presentation was observed for the key secondary endpoint (P for interaction, 0.654).
Conclusions: Physiology-guided complete revascularization, compared with culprit-only revascularization, provided consistent benefit across the whole spectrum of patients with MI. (FIRE [Functional Assessment in Elderly MI Patients With Multivessel Disease]; NCT03772743).
背景：完全血运重建对ST段抬高型心肌梗死（STEMI）患者的有效性已得到公认，但对非ST段抬高型心肌梗死（NSTEMI）患者的研究较少：本研究旨在评估在 STEMI 和 NSTEMI 老年患者中，完全血运重建与单纯罪魁祸首血运重建相比，是否具有一致的预后：在FIRE（多血管疾病老年心肌梗死患者功能评估）试验中，1,445名老年心肌梗死（MI）患者被随机分配接受单纯死因再通术或生理学指导下的完全再通术，按STEMI（n = 256例单纯死因再通术 vs n = 253例完全再通术）和NSTEMI（n = 469例单纯死因再通术 vs n = 467例完全再通术）进行分层。主要结果包括1年内死亡、心肌梗死、中风或血管再通的复合结果。主要次要结果包括 1 年后心血管死亡或心肌梗死的复合结果：在整个研究人群中，生理学指导下的完全血管再通减少了主要和关键次要结果。54例（21.1%）STEMI患者随机接受了单纯罪魁祸首再通术，41例（16.2%）STEMI患者接受了完全再通术（HR：0.75；95% CI：0.50-1.13），98例（20.9%）NSTEMI患者随机接受了单纯罪魁祸首再通术，72例（15.4%）NSTEMI患者接受了完全再通术（HR：0.71；95% CI：0.53-0.97）。同样，在关键的次要终点方面，也没有观察到与初始临床表现有关的异质性信号（交互检验的P值为0.654）：结论：生理学指导下的完全血运重建与单纯罪魁祸首血运重建相比，能为所有心肌梗死患者带来一致的获益。(FIRE[多血管疾病老年 MI 患者功能评估]；NCT03772743）。
期刊介绍：
The Journal of the American College of Cardiology (JACC) publishes peer-reviewed articles highlighting all aspects of cardiovascular disease, including original clinical studies, experimental investigations with clear clinical relevance, state-of-the-art papers and viewpoints.
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