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

医学 罪魁祸首 血运重建 危险系数 心肌梗塞 内科学 临床终点 冲程(发动机) 随机对照试验 心脏病学 外科 置信区间 机械工程 工程类
作者
Andrea Erriquez,Gianluca Campo,Vincenzo Guiducci,Javier Escaned,Raúl Moreno,Gianni Casella,Mila Menozzi,Enrico Cerrato,Giorgio Sacchetta,Alberto Menozzi,Ignacio J. Amat‐Santos,Enrique Gutiérrez,Roberto Scarsini,G Vadalà,Giuseppe Andò,José Luis Díez Gil,S 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
出处
期刊:JAMA Cardiology [American Medical Association]
卷期号:9 (6): 565-565 被引量:3
标识
DOI:10.1001/jamacardio.2024.0804
摘要

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 benefit of physiology-guided complete revascularization vs a culprit-only strategy in patients with HBR, MI, and multivessel disease. Design, Setting, and Participants This was 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. Trial Registration ClinicalTrials.gov Identifier: NCT03772743
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