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Complete vs Culprit-Only Revascularization in Older Patients With Myocardial Infarction and High Bleeding Risk: A
Andrea Erriquez1, Gianluca Campo1, Vincenzo Guiducci2
1Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy.
JAMA Cardiology
|May 8, 2024
Summary
For older patients with myocardial infarction (MI) and high bleeding risk (HBR), physiology-guided complete revascularization significantly reduces adverse events compared to a culprit-only strategy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- High bleeding risk (HBR) is associated with poor prognosis in myocardial infarction (MI) patients.
- The benefit of complete revascularization in HBR patients post-MI remains unclear.
Purpose of the Study:
- To compare physiology-guided complete revascularization versus a culprit-only strategy in patients with HBR, MI, and multivessel disease.
Main Methods:
- Prespecified analysis of the FIRE randomized clinical trial data.
- Inclusion of patients aged 75+ with MI and multivessel disease.
- Randomization to physiology-guided complete revascularization or culprit-only strategy.
Main Results:
- 71% of 1445 patients met HBR criteria and faced higher risks of adverse events.
- Physiology-guided complete revascularization significantly reduced the primary endpoint (death, MI, stroke, revascularization) in HBR patients (HR, 0.73; 95% CI, 0.55-0.96).
- No interaction between revascularization strategy and HBR status for primary/secondary endpoints.
Conclusions:
- HBR is common in older MI patients and increases adverse event likelihood.
- Physiology-guided complete revascularization is effective in reducing ischemic events in HBR patients compared to culprit-only strategy.
